Contents

1.Epidemiology.2. Screening 3.
Communicable Diseases4. Non-
communicable Diseases.5. Family
Welfare6. Population and Demography7.
Health Care Administration8. Nutrition9.
MCH 10. Environment 11. International
Health12. Health Information Systems13.
Concepts in PSM 14. Occupational
Health15. Social Medicine16. IEC
2.
1Epidemiology
1. Define Epidemiology
A. Epidemiology is defined as the distribution and determinants of disease
frequency or health events in man. Modern dayepidemiology is different
from the earlier period where it just referred to as study of epidemics.
It now includescomprehensive methods for control of diseases,
including non-communicable diseases. Distribution refers to the time;
placeand person characteristics of disease while the determinants
(what determines disease) are generally characterized as agent,host
and environmental factors. Since freedom from disease allows an
individual to remain healthy, it is also important tofind out how and why
individuals do not suffer from disease and remain healthy. Such analyses will help
in finding solutionsto disease and maintaining good health.
2. What are the uses of epidemiology?
A. The major uses of epidemiology are:a. To assess the magnitude or
burden of disease in a community. It, therefore, helps in studying the
occurrence of disease ina population. b. To assess the health status of
communities. It, therefore, helps in establishing a community
diagnosis.c. To search for determinants of disease. To find out how and why
disease is caused is a major use of epidemiology.d. To estimate
an individual’s risks and chances of suffering from a disease and to
establish the prognosis in an individualsuffering from disease.e. To
plan comprehensive health services, including specific strategies and
ways and means of implementation.f. To evaluate strategies and
interventions for disease control. Such evaluation helps in identifying
weaknesses and tosuggest remedial measures for the future.
Evaluation of costs and benefits or effectiveness of specific
interventions is also anintegral use.g. To complete the natural history
of disease. In a hospital setting only the terminal cases are seen and
how disease starts and presents in its initial stages is only possible by
studying disease in the community.h. To forecast future disease
trends.i.To identify syndromes.
3. What is the epidemiological triad?
A.Disease is caused by an interaction between agent,
h o s t a n d e n v i r o n m e n t a l c h a r a c t e r i s t i c s . W h e n a l l three
are in harmony, health is ensured but maladjustment in their
relationships leads to disease. These threefactors together constitute
the epidemiological triad.

4. What is the difference between retrospective and prospective studies?

A.Retrospective studies start after a disease has occurred and the
investigator looks back in time to find out what agents
or characteristics (including habits) the individuals were exposed
to and which could lead to disease. Case control studies areexamples
of retrospective studies. In prospective studies individuals are
identified before occurrence of disease and they arefollowed up to see
which individuals develop disease. The characteristics or exposures of
these individuals to diseasecausing agents are compared with the
characteristics of individuals who do not suffer from disease. This
helps in searchingfor determinants of disease.
5. What is a case control study?
A. A case control study is an epidemiological study where a group of
individuals with disease are compared with a group of individuals
who are not suffering from disease in terms of specific disease
causing exposures. Since the starting point is agroup of people who
already have suffered from the disease, this is labeled as
a retrospective study.
Advantages of case control studies
– Relatively quick and easy to undertake. – Relatively cheap to
undertake. – Only method useful in rare diseases. – Not enmeshed in
problems of follow-up as the data iscollected at one point in time. – Can be
used to study the effect of many exposurevariables on a single
disease outcome.
Drawbacks of case control studies
– Prone to selection and recall bias. – Can’t measure relative risk or
provide incidence estimates. – Sometimes the occurrence of the
exposure in terms of time, i.e. whether it occurred before the
disease may be difficult todecipher. – Can’t be used for rare
exposures. – Designing the study is not an easy task.
6. What is a cohort study?
A. Cohort studies are forward looking, i.e. they look for the
development of disease in a group of individuals (the cohort)free of
the same at the beginning. The group is followed up over a period of
time. During this period some persons willdevelop the disease under
study while others will remain free of the disease. The
characteristics(and exposure to disease causing factors) are compared
between those who suffer from disease and those free from
thedisease. The literal meaning of the term ‘cohort’ refers to a group
that shares similar characteristics.Thus, it implies that one needs to
identify groups of populations who are free of the disease being
studied and who aresimilar in all respects, except the specific
exposure variable or characteristic whose effect is being related to the
disease being studied. These groups are then followed up for the period of time
that it takes for the disease to develop.
7. What is a Randomized Controlled Trial?
A. A randomized controlled trial is an experimental method where
individuals are randomly allocated to an experimental or a control
group and the effect or response of a drug or intervention is compared
between the two groups. The two keyfeatures are ‘randomization’ and
‘controlled’. To ensure that there is no bias on part of the investigator,
these trials are‘blinded’ – single blind means the patients do not know what the
intervention is; ‘double’ blind means that neither the patient nor the researcher
knows what the drug/ intervention package is while ‘triple’ blind
means that the analysis team alsodoes not know which is the
experimental and which is the control group till the study has been
completed.
8. What is a Community Trial?
A. A community trial is a modification of the clinical trial where
instead of individuals being allocated to experimental or control groups,
whole communities are randomly allocated to receive specific interventions and
analysis is done for wholecommunities rather than for individuals in the
communities. Vitamin A supplementation trials, iron supplementation
or iodine supplementation trials are all examples of community trials.
9. What is a vaccine trial?
A. When a randomized control trial is done to test the efficacy of a
vaccine in preventing disease, it is called a vaccine trial.
10. What is the difference between Descriptive and Analytical Epidemiology?
A. The descriptive methods are mostly concerned with the
distribution of disease/health condition, while the analyticalmethods are
concerned with the determinants of disease/health condition.

There are a number of different descriptive methods: – Ecological

/correlational studies. – Case reports/case series. – Cross-
sectional designsAnalytical studies are concerned with the
determinants of disease rather than with the distribution. They focus
attention onways to prove a hypothesis suggested by the earlier types
of studies. Based on the analytical method used, they can becategorized
into two types: – Observational methods – Experimental methods.In the
observational methods, the disease phenomenon is not in the grip of
the investigator. The clinician – investigator onlyrecords the sequence
of events as they unfold in front of his eyes. The outcome events are
then related to the different inputvariables to understand the dynamics
of disease causation. In the experimental studies or the intervention
studies, theresearcher selects a group of patients and then decides how
to intervene/treat the group, and then records the differences.Thus,
one group of individuals is labeled as an experimental group and
is given some ‘treatment’, while the other group islabeled as the control
group among whom either a placebo may be used or nothing may be done.These
studies can be further categorized as follows:Observational Studies
Experimental Studies – C a s e c o n t r o l s t u d i e s –
Intervention studies –
C o h o r t s t u d i e s w i t h / w i t h o u t c o n t r o l – C l i n i c a l trials
(RCT) – Community trials
11. What is sampling?
A. Sampling can be defined as the process of selecting a statistically
determined number of subjects from the universe or reference
population, which provides an accurate estimate of the problem being
studied. Thus, only a proportion of thereference population is
covered, but the results approximate the actual prevalence of
the disease condition in the reference population. Strictly speaking,
the results obtained are applicable only to the population from which
the sample was drawn, but the results are generally extrapolated to
other populations that are similar to the reference population. A
sample is theminimum number of people or units who need to
be contacted or examined to obtain statistically acceptable results
andthereby permit valid inferences to be drawn.
12. What are the different sampling methods that you know of?
A. The different sampling methods include simple random sampling,
systematic random sampling, stratifiedrandomsampling, cluster
sampling, multistage sampling and purposive sampling. Purposive
sampling is not used in epidemiologicalor health sciences as it gives
biased results. All other sampling methods are called probability-
sampling methods.
13. What is the difference between simple and stratified random sampling?
A. In this method, every individual has an equal chance of
being selected in the sample. The first step involves enumerationof
the total population wherein every individual is sequentially
numbered from 1…n (n =last member in the population).
Theenumeration list of the total population from which the sample is drawnis
called the sampling frame. The next stage is theactual selection of the sample,
which can be done by different methods like drawing numbers from a hat or
picking numbersfrom a random table, etc. Stratified sampling is done to give the
different population subgroups an equal chance of beingselected. In this way,
male/ female or urban / rural can be given adequate representation to
reduce bias.
14. What is systematic sampling?
A. Systematic sampling is a method of probability sampling, which is
used to simplify the selection procedure. After enumerating the units
i.e. villages, houses, etc. they are selected at a predetermined interval,
i.e. every nth unit. The procedure has the advantage of
easy administration in the field, but is inferior compared to the simple
random sampling
15. What is cluster sampling? Give examples of wherecluster sampling has
been used in reproductiveand childhealth?
A. For conducting surveys or epidemiologic investigationson large
population groups, the simple random technique is not of much use.
This is because construction of the sampling frame becomes very
difficult when there are a large number of individuals to be
enumerated. In such situations, groups, rather than individuals, can be
selected in the initial stage of the sampling process. In the selection of
the final stage units, instead of randomly selecting the individuals to
be included, allthe individuals in the identified cluster are
examined.EPI vaccine coverage surveys adopted the cluster sampling
technique and now this technique is widely used in manysituations
where coverage / lameness / disability are surveyed.
16. What is an epidemic?
A. The occurrence of a disease clearly in excess of normal
expectations is called an epidemic. The number of cases, whichshould
be diagnosed before declaring an epidemic status, depends on
the number of cases routinely seen in that area. In anarea where a
disease has not been seen for many years, even the occurrence of a
single case may be sufficient to call it anepidemic. Some people look
at the mean (or average) number of cases and if the cases are beyond
two standard deviationsthey call it an epidemic

17. Give some examples of epidemic diseases, which have occurred in India recently?
A. The recent outbreak of plague in India where cases were not seen for many
years is an example of an epidemic.HIV/AIDS is also a disease with epidemic
proportions. Epidemics of dengue, JE are also reported from time to
time.Epidemic diseases need not necessarily be communicable diseases.
Therefore, WHO also looks at smoking as an epidemic.
18. What is a pandemic?
A. An epidemic which breaks out across many continents is called a pandemic –
i.e. occurring across the world.
19. Name some pandemic diseases
A. HIV/AIDS and smoking can be called as modern day pandemics as they
have affected millions of people across theworld. Cholera was one of the most
common diseases, which assumed pandemic proportions. Drugresistant
tuberculosis isalso a pandemic. Plague was also pandemic in historical times.
20. What are endemic diseases? Name some endemic diseases
A. The constant, continuous or usual presence of a diseasein a defined
geographic area or delimited territory is called anendemic disease.
Hyperendemic refers to a persistent intense transmission in an area while
holoendemic means a diseasestaring early in life and affecting most of the population.
An endemic disease may become an epidemic if the number of cases usually seen
suddenly increase in proportion. Malaria, tuberculosis, leprosy, filariasis,
etc. are examples of endemicdiseases.
21. What is prevalence rate?
A. The proportion of persons suffering from a specific disease out of the
population normally residing in that area, at a particular point in time, is called
the prevalence rate. It includes both the new cases as well as the old cases
occurring in thearea at the point in time when the examination was undertaken.
The point in time can be one day or one year or moredepending upon how much
time it takes to examine the population residing in an area. The persons suffering form
thenumerator while the population from which they hail is called
the denominator. It should be seen that the numerator is partof the denominator.
For example, if female genital discharge is being studied, the denominator
should only include the population who are at risk of suffering from a disease
i.e. women. Prevalence rate can be represented as a percentage if adisease is
common or as per 1000 or 100,000 population if disease is rare.
22. What is incidence rate?
A. Incidence rate refers to the number of new cases occurring in a population
over a specified period of time. The numerator should be part of the
denominator as in prevalence rate but unlike as in prevalence rate only new
cases are considered. If acase started before the reference period but is
continuing to the present, it is not considered in the numerator. E.g. if
thereference period is from 1st Jan – 31st Jan 2002, cases,which started before
1st Jan 2002 but are still suffering will not beincluded in the numerator.
Incidence rate is generally depicted as per 1000 or 100,000.
23. What is the relationship between prevalence and incidence?
A. Prevalence of a disease is the product of incidence and the duration of
disease ( P= I xD). Therefore, prevalence of adisease depends not only on the actual
number of people who develop a disease but also on the duration of a disease. For short
duration diseases like common cold, the prevalence and incidence are almost
identical while for chronic or long-standing diseases like tuberculosis, leprosy
or blindness the prevalence is always much higher than the incidence.
24. How does prevalence of a disease increase?
A. The prevalence of a disease can increase in the following conditions: – The
duration of the disease is very long (i.e. chronic conditions) – The level of
incidence i.e. the higher the incidence, the larger is the prevalence. – Improved
methods of diagnosis that lead to detection of larger number of cases than
before. – Availability of effective treatment, which prolongs life such that the individual
lives longer while still suffering from thedisease. – A sudden migration of cases into
an area where the disease was not very common earlier.
25. How does prevalence of a disease decrease?
A. – A very short duration of the disease (applicable to the acute disease
conditions). – A very low incidence of disease – Lack of proper diagnostic
equipment or skills for the detection of disease. – Diseases with a high mortality
such that very few individuals survive – Out migration of diseased individuals
26. In which disease conditions is prevalence more appropriate and why?
A. Prevalence is most appropriate in long-standing or chronic diseases as the
window period in which a diagnosis can beestablished is much higher and
therefore, cases will not be missed during a survey. On the other hand, short
durationdiseases would occur and recover so fast that they cannot be examined
(or are missed) at a specific point in time.

27. In which diseases is incidence more appropriate and why?

A. Incidence is most appropriate in disease of a short duration as such diseases
may occur more than once during a reference period and all the episodes may
not be captured if the prevalence of the disease were to be measured. E.g. If a
study weredone on diarrhea, if the number of people suffering from diarrhea in
a one-year period was measured, it would always bemuch lower than the
number of episodes of diarrhea that the population staying in that area would
suffer.
28. What do you mean by a primary case?
A. The first case of a disease which occurs in a community/area is called the
primary case. Many a time, the primary casemay not be recognized as the
disease comes to notice much later. Only by historical review can, the possible
primary case, be located in such a case. In some disease like acute conjunctivitis
a number of primary cases may occur almost at the same point in time. In such a
scenario, the primary cases are referred to as “Co–primaries”
29. What do you mean by an index case?
A. The first case, which comes to the attention of the health authorities in an
area, is referred to as the index case. Such acase may or may not be the primary
case.
30. What is Secondary Attack Rate?
A. The secondary attack rate refers to the number of cases occurring among contacts of a
primary case within the knownincubation period of the disease. The denominator
refers to the number of susceptible contacts who are in close touch withthe
primary case. However, if whether a person among the contacts has previously
suffered from the specific disease anddeveloped immunity is not known, then all the
contact should be considered in the denominator. Such personsare usually other
members of the family / neighborhood / institution who stay with the primary
case.
31. What is a secular trend?
A. If the pattern or trend of disease frequency changes only over many years
then it is called a secular trend.
32. What is a cyclic trend?
A. If the occurrence of disease changes over a short duration of time like a year,
it is called a cyclic trend.Most epidemic diseases in India show a cyclic
trend.Some diseases change in frequency over seasons and such changes are
referred to as seasonal changes – Measles and chickenpox are examples of such
diseases.
33. What is herd immunity? Give examples where it is important?
A. The immune status of a group of people/community is called herd immunity as it is the
immune status of the ‘herd’ of people. For many communicable diseases, an
outbreak of disease is only possible if the level of immunity is sufficiently low and
there are a large number of susceptibles in the population. In diseaseslike poliomyelitis,
diphtheria, measles etc., herd immunity plays an important role. However, in
adisease like tetanus or rabies where every individual is at risk unless
specifically protected, herd immunity plays no role.
34. What is a nosocomial infection?
A. An infection occurring in a patient in a hospital or other health-care facility
and in whom it was not present or incubating at the time of admission or arrival
at a healthcare facility is called a nosocomial infection.It refers to diseases
transmitted from a hospital. Usually such infections are more difficult to
manage as theyare generally resistant to most of the common antibiotics.
Nosocomial infections also include thoseinfections, which were contacted in the
hospital but manifested after discharge, and also infections suffered by staff
members if they contacted the infection from the hospitalized patients.
2.
Screening
35. What do you understand by the term screening?
A. Screening denotes the search for unrecognizeddisease or defect in
apparently (or outwardly)healthy persons by theapplication of rapid
diagnostic tests, examinations or procedures. The basic objective of
screening is to facilitate anearly diagnosis so that the prognosis can
be improved by remedial action.
36. What is mass screening?
A. When all members of a population are screened for disease it is
called mass screening. This is very costly and theyield of cases is
usually too small to warrant such a screening procedure.
37. What is high-risk screening?

A. High risk or selective screening refers to the situation where tests

are offered only to those individuals who are athigh risk of developing
a specific disease. This makes the screening process more focused and
reduces the overall costsas a large number of people who have
extremely remote chances of developing a disease are not screened.
38. What criteria should you look for before screening for any disease?
A. The following criteria should be satisfied before embarking on
screening:1. The condition should be an important public health
problem.2. The natural history of the condition from the latent to
manifest disease should be adequately understood.3. There should be
a recognizable latent or early asymptomatic stage of the disease,
during which identification willlead to improved prognosis or
outcome.4. There should be an accepted and effective treatment for
the patients with recognized disease.5. Facilities for full diagnostic
work-up and treatment should be available.6. There should be a
suitable test available which should be valid.7. The test should be
acceptable both to the public as well as the professionals.8. There
should be an agreed policy on whom to treat as patients, including the
management of borderline disease.9. Case finding should be a
continuous process.10. The cost of early diagnosis and treatment
should be economically balanced in relation to the total expenditure
onmedical care (The opportunity cost should be justifiable).These can
be classified as:• Disease criteria• Test criteria• Diagnostic
and treatment infrastructure criteria
39. What is sensitivity?
A. This refers to the proportion of truly diseased individuals in
the population who have been correctly identified asdiseased by the
screening test. A test with a high sensitivity gives only a few false
negatives.
40. What is specificity?
A. This refers to the proportion of the normal individuals who are
correctly labeled as nondiseased by the screeningtest. A test with a
high specificity will only give a few false positives. It is desirable that
a screening test should have ahigh sensitivity and specificit
increase the reach of services under the Act.Employees contribute 2.5% of their
wage whilethe employer contributes 5% of the wage bill.Under the Act, the
following benefits are extendedto the workers:
Communicable Diseases
41. What are the different ways in which communicable diseases
can be transmitted?
A. Communicable disease can be transmitted in a number of
ways:a. Direct transmission: Contact transmission b.Indirect
transmission: Vehicle (fomite) borne,vector-borne, air-borne
(droplet nuclei and infected dust) c. Transplacental
42. What is the period of communicability?
A. Period of communicability or communicable period rfers
to the time during which an infectious agent may
betransferred directly or indirectly from an infected person to
a susceptible person. This period is usually equal to
themaximum known incubation period for that disease.
43. What is contact transmission?
A. When disease is spread by direct contact with an infected
person, it is called contact transmission. This may be
bykissing, touching, biting or sexual intercourse. Ringworm,
scabies, yaws, etc. are examples of such diseases.
44. What are zoonoses?
A. An infectious disease transmissible under natural
conditions from vertebrate animals to man is called a
zoonoses.There are over 150 disease common to man and
animals. These include anthrax, psittacosis, liver fluke, T.
solium, T.saginnata, bovine TB, salmonellosis, brucellosis,
scabies, plague, typhus, yellow fever and KFD.
45. What is passive immunization?
A. Passive immunization refers to the injection of specific
protective antibodies (hyper immune serum, immune
serumglobulin, etc.) to provide immediate protection to an
individual. Transplacental transfer is also an example of
passiveimmunization. Here, readymade antibodies are
provided to an individual especially in an emergency when
one cannotwait for the body to produce antibodies. Examples
are diphtheria, tetanus, and rabies, etc.
46. What is active immunization?

A. In active immunization, a live/killed vaccine is injected

and the body reacts by producing antibodies, which makethe
individual immune and protect against attack by infectious
agents. Active immunity is also achieved after sufferingfrom a
disease like measles, chickenpox, etc. Active immunity is
long lasting and more effective in preventing futuredisease.
The only drawback is that it takes time for the body to
produce antibodies and therefore active immunization
isusually not useful in an emergency. Rabies is an exception
because the incubation period of the disease is long.
47. What is the incubation period for chickenpox?
A. Incubation period is 7-21 days and commonly it is 14-16
days.
48. How does chickenpox spread?
A. It can affect people of all ages but most commonly children
below 10 years are affected as they do not have protective
antibodies. It is most commonly spread due to respiratory
secretions from infected persons, which areteeming with the
virus. Crusts of chickenpox are not infective.
49. What is the incubation period for measles?
A. The incubation period of measles ranges from 8 –16 days
with an average incubation period of 10 days.
50. What are the different life threatening complications of
measles?
A. Common life-threatening complications of measles include
broncho-pneumonia and diarrhea. Encephalitis can alsooccur
rarely.
51. When is measles most infectious?
A. Measles is most infectious 4 days before to 5 days after the
rash appears.
52. How does the rash of measles differ from the rash of
chickenpox?
A. An eruptive rash appears in measles as dark red macules or
maculopapular granules, first evident behind the earsand at
the junction of the scalp and forehead and then spreading over
the face, trunk and limbs, very rapidly. The rashlasts for 4-6
days and disappears in the same order in which it appeared. It
dries off leaving a brawny discoloration of the skin. The rash
in chickenpox has a centripetal distribution – first appearing
on the trunk and then spreading towardsthe periphery. The
palm and soles are not affected. The rash is seen mostly on the
flexor surfaces and appears on thevery first day and thereafter
in crops, evolving very rapidly. The lesions are superficial,
unilocular and are surrounded by a red areola. They are small,
elliptical and mostly discrete with no umblication.
53. What is German measles?
A. German measles is Rubella and is a mild eruptive fever
like measles. It is caused by Rubella virus.
54. What are the complications if a pregnant mother gets
Rubella?
A. The special public health significance of Rubella is that a
child may be born with congenital defects like
deafness,microcephaly, microphthalmia, PDA, septal defects
and other malformations, which are called the Congenital
RubellaSyndromme, if the mother is infected during
pregnancy. The frequency of congenital defects is 20-25% if
infectionoccurs in 1st trimester and less after that.
55. What is MMR vaccine and how and when should it be
given?
A. MMR vaccine is measles, mumps and rubella vaccine,
which is a live, attenuated vaccine and is administered as
asingle IM dose after 1 year of age. If measles vaccine has
been administered to a child at 9 months, MMR should
begiven at 15 months of age.
56. Which diseases do you know of which are planned to be
eradicated?
A. Gineaworm, poliomyelitis and leprosy are three major
diseases, which are on the eradication agenda. Smallpox
wasthe first disease, which was successfully eradicated.
57. What are the diseases caused by rodents?
A. Plague, murine typhus, salmonellosis, Weil’s disease, rate
bite fever, trichinosis, rickettsial pox and
lymphocyticchoriomeningitis are diseases caused by rodents.
58. How can you distinguish Culex from Anopheles mosquitoes?
A. The anopheles lays eggs singly on water while culex lays
eggs in clusters or rafts of 100-200 eggs. Culex eggs areoval
with no air floats while anopheles eggs are boat shaped with
lateral air floats. The larvae of anopheles have nosiphon tubes,
lie parallel to water surface and have palmate hair on
abdominal segments, while in culex, two siphontubes are
present, they hang at an angle and have no palmate hair. Adult
anopheles sit against the wall at an angle,have spotted wings
and palpi are long while adult culex sit parallel to the wall and
the head and body are angled or hunch backed, make ringing
noises in ears, have no spots on wings and the palpi are
shorter in the females.
59. What are the common diseases transmitted by mosquitoes in
India?
A. The common diseases transmitted by mosquitoes in
India are malaria (anopheles), filarial, JE and West Nile
fever (Culex), Malayan filariasis and Chikungunya fever
(Mansonia) and dengue, yellow fever, DHF and Chikunganya
fever (Aedes).

60. What advice on chemoprophylaxis for malaria will you give

to a foreigner visiting India?
A. Chloroqine 300 mg once a week starting 2 weeks
before arrival or latest on the day of arrival and continued for
4-6weeks after leaving the country is useful if there is no
resistance to chloroquine in the area to which the foreigner
istraveling. Sulfadoxine – pyremathamine combination or
mefloquine can also be taken if chloroqine resistance
isreported.

60. What advice on chemoprophylaxis for malaria will you give

to a foreigner visiting India?
A. Chloroqine 300 mg once a week starting 2 weeks
before arrival or latest on the day of arrival and continued for
4-6weeks after leaving the country is useful if there is no
resistance to chloroquine in the area to which the foreigner
istraveling. Sulfadoxine – pyremathamine combination or
mefloquine can also be taken if chloroqine resistance
isreported.
61. What is presumptive treatment?
A. This refers to treating every case of fever presuming it to
be malaria and therefore it is called presumptive
treatment.This consists of 600 mg (4 tablets) of
chloroquine given to a febrile person without waiting for
the report of the bloodsmear.
62. What are Fever Treatment Depots?
A. These are the health facilities where personnel collect the
blood smear and provide presumptive treatment to thefebrile
individuals. If the smear is positive, the health personnel go
back and provide radical Rx.
63. What drugs and how much will you give for radical
treatment of P. falciparam malaria?
A. Radical treatment consists of a single dose of 600 mg
chloroquine plus 45 mg of primaquine.
64. What are impregnated nets?
A. These nets are used for control of malaria and are plastic
nets, which are impregnated with synthetic insecticides.
65. What are the different plasmodium species causing malaria
in India?
A. The species in India are vivax, falciparum and malariae.
66. What is spleen rate in malaria?
A. Children aged 2 – 10 years are examined for
enlargement of spleen and areas are classified according to
endemictyas indicated by the spleen rate :Below 10% - Non
endemic10 – 25% - Hypoendemic25 – 40% - Endemic> 40%
- Hyper endemic.
67. What are the indices for blood surveys for malaria?
A. The main indices are:a. Infant parasite rate: It is a
good indicator of recent infection and is measured by
proportion of blood smears of infants positive for malarial
parasite. b. Children parasite rate: Here blood smears of
children aged 2-10 years are examined.c. Annual parasite
index: This is the most common index used currently. It is
defined as the numberof confirmedmalaria cases per 1000
persons in an area per year.d. Slide positivity rate: Proportion
of slides examined which are positive for the malarial
parasite.e. Slide falciparum rate: Proportion of slides
examined which are positive for falciparum species.f. Annual
Blood Examination Rate: The number of blood slides
examined per 100 population. An ABER of 10% iswarranted
for good coverage of the population under surveillance.g.
Monthly blood examination rate: This should be 1%during the
non-transmission season and 2% during thetransmission
season (July – Oct) in areas under active surveillance and 15%
and 20% respectively (as a proportion of new OPD cases) in
passive surveillance zones.
68. What is active surveillance?
A. In active surveillance, the health worker goes from house
to house to search for cases of fever.One round is completed
in a fortnight and the worker then repeats the visits. Thus
every house is visited everyfortnight. The health worker asks
4 questions:a. Is anybody suffering from fever currently? b.
Did anybody suffer from fever in the pastfortnight?c. Did any
guest with fever come to the house in the past fortnight?d. Did
any fever case leave the area in the past fortnight?Any person
complaining of fever is then given presumptive treatment after
collecting a blood smear.
69. What is passive surveillance?
A. In passive surveillance, any fever case reporting to a health
facility is given presumptive treatment after a bloodsmear is
made.
70. What is Annual Parasite Incidence and how is it important?
A. It is defined as the number of confirmed malaria cases per
1000 persons in an area per year. It is the most sensitiveindex
in use currently. The target for 2000 AD was an API of
0.5% which was more than 2 in 1991.

71. What is the objective of the modified plan of operations in

malaria?
A. The objectives of the modified plan of operations are:a. To
prevent deaths b. To reduce case loadc. To consolidate
achievements made under NMEPd. To maintain the green and
industrial revolution.
72. What is Annual Blood Examination Rate?
A. This is a monitoring tool to ensure that adequate number of
blood slides have been collected. The workers shouldhave
collected blood smears eqivalent to > 10% of the population
residing in an area. This is based on the expectedload of fever
cases in a community in a year.
73. Which are the endemic areas for chloroquine rsistant
malaria in India?
A. All the North East States in the country, parts of
Chttisgarh, Madhya Pradesh, Andhra Pradesh, Jharkhand,
WestBengal and Orissa are endemic areas for chloroquine
resistant malaria.
74. Name some arthropods which transmit diseases.
A. Arthropods, which transmit disease, include mosquitoes,
houseflies, sand fly, tsetse fly, black fly, lice, rat flea,reduviid
bug, cockroaches, ticks, trombiculid mite and cyclops.
75. What do you understand by biological control?
A. Biological control means use of animal species to kill
disease causing vectors. Gambusia and Lebistes fish
have been used effectively in malaria control. Coelomomyces
fungus and some other fungi, bacilli, protozoa and
nematodeshave been tried for biological conrol.This method,
if effective can reduce the harm caused to man and
environment byinsecticides.
76. What are the diseases transmitted by lice?
A. Epidemic typhus, quintana, trench fever, relapsing fever
and secondary dermatitis are some disease caused by lice.
77. What are arboviruses?
A. They are defined as those viruses that are maintained in
nature principally or to an important extent through biological
transmission between susceptible vertebrate hosts by
haematophagus (blood feeding) arthropods.More than a 100
arboviruses are known to produce disease in man.
78. What diseases are transmitted by hard tick?
A. Hard ticks transmit tick typhus, viral encephalitis, KFD,
tularemia, tick paralysis and babesiosis.
79. What diseases are transmitted by soft tick?
A. The soft ticks transmit Q fever and relapsing fever.
80. How is Diphtheria spread?
A. Diphtheria is spread through direct droplet/ direct air-borne
routes and indirectly through inhalation of contaminateddust
by dried particles of the diphtheria membrane. It can also be
spread through contaminated milk, fomites,convalescent or
healthy carriers, cross infection in wards & infection of
wounds or cuts in skin or mucousmembrane, including
conjunctiva.
81. What is the Schick test?
A. The Schick test was done to identify individuals whoare
susceptible to diphtheria and those who are allergic to
thetoxoid use in the vaccine. With universal immunization
becoming the rule, the use of the test has
decreasedtremendously. The test was done by intradermal
injection of 0.2 ml of Schick test antigen or toxin in one
forearm andheated toxin in the other forearm as a control.
82. Which strain is used for making BCG vaccine?
A. The Danish 1331 strain of the BCG antigen has been
recommended by the WHO for production of BCG vaccine.
83. How is BCG vaccine given?
A. 0.1 ml of BCG vaccine (producing a weal of 8 mm) is
given intradermally over the deltoid muscle using
a tuberculinsyringe. In neonates below 4 weeks of age, 0.05
ml is recommended. The dose is given immediately after birth
or assoon as possible after birth, preferably before 6 weeks
of age.
84. What are the normal reactions that occur after giving BCG
vaccine and what advice should be given to themother?
A. The weal raised immediately after giving the BCG vaccine
disappears within a few hours. Nothing happens over thenext
two weeks. Redness and induration at the site are seen in the
third week. A papule then develops reaching itsmaximum size
in the 4th week. The papule cracks,discharges pus and is
gradually changed into a crust during the 5th – 6th week. The
scab falls off during the 7th – 8th week leaving a small oozing
ulcr which heals and leaves a scar about 5mm in diameter.
These reactions are often more marked in positive reactors.

Mothers should be sensitized about all thenormal reactions so

that they do not get worried. They should be told not toapply
any medicine or lotion to the injection site when the crust
forms or when pus is seen. They should be told to look for
enlargement of regional lymph nodes, keloid formation or an
abscess formation and to bring the child to the clinic if any
such complications are seen.
85. What is the Tuberculin test?
A. The tuberculin test is performed to screen individuals who
are already infected and those who are highly susceptibleto
the disease. Tuberculin containing PPD (purified protein
derivative) prepared from the RT strain along with Tween80
is injected intradermally. The injection is given on the anterior
side of the forearm and the result is read after 48 –
72hours.The induration is measured and any induration
greater than 10 mm is taken as positive. Strong reactors
(morethan 20 mm induration) have more chance of
developing active TB. Similarly weak reactors (< 5 mm) also
have ahigher chance of infection. In countries where BCG
vaccine is given at birth, tuberculin testing loses its value.
86. What is chemoprophylaxis? Gives some examples
A. Chemoprphylaxis is the use of drugs to prevent onset of
disease in individuals who are exposed to disease
causingorganisms. This can be of two types – Primary (giving
drugs before a person isapparently infected) or secondary
(after a person is infected but disease has not manifested).
Malaria and TB are twodiseases where the principles of
chemoprophylaxis are put to good use.
87. What is Short Course Chemotherapy?
A. Short course chemotherapy is now being widelyused in
TB. A combination of 4 drugs is given for the initial
periodfollowed by 2-3 drugs during the follow up phase of 4-6
months. The total duration of most short course regimens is 6-
8 months. A number of regimens have been developed.
Common ones use Rifampicin, INH,Streptomycin
andPyrazinamide for 2 months followed by Rifampicin and
INH for 4-6 months. The intensive phase with four
drugsrapidly converts a sputum positive person to sputum
negative and therefore decreases the transmission potential of
theaffected individual.
88. What is DOTS?
A. A major problem in tuberculosis is the lack of compliance
with the recommended drugs by the patients and thisleads to
inadequate treatment, which further is responsible for
multi drug resistance. To avoid this, under
the NationalProgramme, the patients are made to take the
drugs in the presence of the health workers. This is therefore
calledDirectly Observed Treatment Schedule (DOTS).
89. What is DOTS-Plus?
A. Because of the emergence of multiple drug resistance to
drugs used as the primary line of management for TB,
theWHO has embarked on a programme of directly
supervised regimens using drugs where no resistance has
beenreported. These regimens are only to be used in areas
specified as suffering from MDR TB. It is also important that
thesecondary drugs are not used routinely and sold across the
counter in such areas to avoid the emergence of resistance
tothese drugs. This is called DOTS Plus.
90. What is RNTCP?
A. The National TB Control Programme has been revamped
with the initiation of directly observed treatment regimesand
an augmentation of outreach activities to increase the
compliance of patients to recommended drugs. These
newinitiatives in the programme have resulted in the national
programme now being called Revised National TB
ControlProgramme.
91. What do you understand by defaulter action?
A. A patient who does not come back for drugs for one month
from the due date for medicines is called as a person lostto
treatment. A postcard is sent to the patient after a week of
default and the patient’s home is visited if the patient stilldoes
not come back. This is called defaulter action. With short
course regimens default has decreased during the initial phase
of treatment

93. What is the prevalence rate of tuberculosis infection in India?

A. The prevalence of TB infection is the percentage of individuals in the
community showing positive reaction totuberculin test. Its usefulness has
decreased in recent years due to widespread BCG immunization. A third of
the Indian population is infected.
94. What do you understand by Annual Infection Rate in TB?
A. This is also called the incidence of infection and tuberculin conversion
index. It is the proportion of personsconverting from tuberculin negative to
positive in a particular year. Annual infection rate in infants and children is
the best indicator of transmission of infection in a community. The
prevalence rate of TB disease is 4 per 1000 population while the incidence rate
of disease is 1 per 1000 population.
95. How many radiologically active cases and how many sputum positive
Tuberculosis cases can you expect in apopulation of a district with 1-2 million
population?
A. Each district is likely to have 20,000 radiologically active cases including
5000 sputum positive cases at any point intime. Annual incidence of new cases
is expected to be 2000.
96. Who is labeled as a case of tuberculosis?
A. A case of TB is an individual who is sputum positive and is therefore
capable of transmitting infection.
97. What is the difference between a cases and a suspect of TB?
A. A suspect is a person who is sputum negative but has radiological
evidence of Tubercular shadows in the lungs.Therefore, a case is infectious
while a ‘suspect’ is not infectious.
100. What is a District TB Centre?
A. A district is the nerve centre for TB control activities under the NTCP. All
patients are registered with the DistrictTB Centre and drugs are provided from
here. All defaulter action in addition to maintenance of the live register is
theresponsibility of the District TB Centre.
101. What is the danger signals signifying severe disease in Acute Respiratory
Infections?
A. Danger signals, which signify very severe disease, are:a. Child stops proper
feeding b. Child too sleepy or difficult to wake up c. Stridor even when the
child is calm.d. Wheezing e. Convulsions f. Severe malnutrition g. A very
young infant who has fever or is cold to touch.
102. Name some food-borne diseases and specify measures of control for these
diseases?
A. Common food-borne diseases are cholera, typhoid, amoebiasis, bacillary
dysentery, taeniasis, trichinellosis,trichuriasis, hydatid cyst & food poisoning
103. What is the incubation period of cholera?
A. The incubation period for cholera ranges from 1 – 5 days. Most commonly it
is 12 hours to 2 days.
104. How can you differentiate cholera from food poisoning?

A.The following table illustrates the differential diagnosis of cholera and

food oisoning:
105. What is ORT?
A. Oral Rehydration Therapy is the cornerstone ofmanaging dehydration in
diarrhea. It is estimated that it can save anestimated 4 million children dying
from diarrhea every year. Some people differentiate between ORT and ORS.
Theconstitution of packed physiological salts as a solution is called ORS while
the preparation of home-made solutions for oral rehydration are referred to as
Oral Rehydration Therapy.The contents of the Oral Rehydration Salts solution
approximate the water and electrolyte composition of diarrhealstool, which is
isotonic in nature.
106. How can Oral rehydration fluid be made at home?
A. Home-made rehydration fluid can be made by adding sugar and salt to water.
Eight heaped teaspoons of sugar and 1level teaspoon of salt should be added to
one litre of clean water. The salt and sugar should be dissolved completely.The
patient should be given as much of the solution as he can take comfortably.
Small sips can be repeated at frequentintervals. Once the solution is prepared it
should be consumed within 24 hours and whatever is left over should be
discarded and not consumed after 24 days. Fresh solution should therefore
be prepared everyday.
107. What is the composition of WHO formulated ORS?
A. The composition of standard WHO formulatedORS is as follows: – Sodium
chloride: 3.5 grams – Sodium bicarbonate: 2.5 grams – Potassium chloride: 1.5
grams – Glucose: 20 grams – Water: One litre This provides: 90 meq/litre of
Sodium 20 meq/ litre of Potassium 80 meq/ litre of Chloride30 meq/ litre of
Bicarbonate ORS containing sodium bicarbonate has short shelf life in hot,
humid conditions. Sodium bicarbonate reacts with glucose in the presence of
dampness (water) and the powder becomes discoloured and
lesseffective.Therefore, replacing 2.5 grams of sodium bicarbonate with 2.9
grams of trisodium citrate increases stabilityof ORS and also reduces stool
output.
108. How long can the ORS be used after preparation?
A. Once prepared, ORS should be consumed within 24 hours. After that
period, whatever is left over should be discarded and fresh solution should be
prepared.
109. What are the features of Salmonella food poisoning?
A. Salmonella food poisoning is characterized by an incubation period of 12-24
hours, abdominal pain,
diarrhea, vomiting and fever. The organisms most commonly multiply rapidly
in animal foods like milk and milk preparations, meat, fish, eggs, ice creams,
puddings, pastries, sausages and meat pies, etc. and so history of intake of such
foods is elicited.
110. What are the features of botulism?
A. In botulism, change of voice, diplopia, ptosis, cranial nerve palsies and
obstinate constipation are observed. Historyof consumption of tinned food is
usually observed. An incubation period of 12-36 hours is seen. Death usually
occursin 3- 7 days and mortality is high (40%).
111. Who is labeled as a convalescent carrier?
A. A convalescent carrier is one who sheds infective micro-organisms during
the period of convalescence. In typhoidthis is for a period of 1-2 weeks after the
temperature comes down.
112. Who is called a permanent carrier?
A. A permanent carrier is one who continues to shed organisms forever after the
disease has been cured. This is seen intyphoid where the gall bladder
and kidneys are involved and bacilli are passed for a long time with interspersed
periodsof remission. 2.5% of typhoid cases develop into permanent carriers.
113. What is the incubation period of Typhoid?
A. The commonly observed incubation period of typhoid is 10 – 14 days, but it
can range from 4 – 21 days.
114. What vaccines are used for active immunization against Typhoid?
A. A number of vaccines are used for active immunization against typhoid.
These include: – T A B v a c c i n e – A K D v a c c i n e – B i v a l e n t
v a c c i n e s c o n t a i n i n g S . t y p h i a n d S . p a r a t y p h i – Live
attenuated oral vaccine (Ty 21a)TAB vaccine is the earliest vaccine developed
and was introduced in 1896.Live vaccines are now routinely used andare very
effective and have less side effects compared to the killed vaccines.
115. How many doses of oral typhoid vaccine are given for primary immunization?
A. A single dose of oral vaccine provides long-term immunity. Booster doses
should be given every 5 years.
116. When should booster of acetone killed typhoid vaccine be given?
A. Booster doses should be given every 3-5 years.
117. What advice should you give to a person who is being given AKD typhoid
vaccine?
A. A person given AKD vaccine should not indulge in hard physical work on
the day of injection as this may lead tomore adverse reactions. Fever, myalgia
and rash at the injection site are commonly seen. The myalgia can bedebilitating
and if the whole family is immunized at the same time, there may be nobody fit
to cook for thatnight!! All these reactions are transient and go away within 24-
36 hours.
118. Who is the reservoir of infection in Amoebiasis?
A. Man is the reservoir of infection in Amoebiasis.
119. What is the difference in incubation period of hepatitis A and hepatitis B?
A. The incubation period for hepatitis A is 15-50 days while it is 50-150 days
for hepatitis B.
120. What is surface antigen and how is it useful?
A. The surface antigen in hepatitis B (HBsAg) can be detected in blood for
several weeks before theonset of symptoms and persists for weeks or months.
Its continued presence indicates a chronic infection.
121. How is hepatitis B transmitted? How does this differ from other hepatitis causing
viruses?
A. Hepatitis B is transmitted through body fluids including blood and through
sex where exchange of body fluids takes place. The routes of transmission can
be categorized as follows: – Parenteral or percutaneous: Through infected
blood, blood products, syringes, transfusion apparatus, etc. – Vertical or
perinatal spread: Mother to infant transmission can occur when the mother is a
chronic carrier or suffersfrom acute infection during the first trimester of
pregnancy. The infection can also occur during passage throughthe birth canal
or during the post-natal period due to close contact. – Permucosal spread:
Blood, saliva, vaginal fluids and semen are infective.
122. What is the incubation period of polio?
A. The common incubation period is 7-14 days with an overall range of 3-35
days.
123. How is the prevalence of polio estimated in the community?
A. The prevalence of polio in the community is assessed by conducting
lameness surveys in the community amongchildren aged 0-10 years. Lameness
in children aged 0-4 years is most indicative of the current level of the problem

124. What are the different types of vaccines available for polio?
A. There are two types of vaccines available for prevention against
polio – One is a killed vaccineand is injected (Salk vaccine) and the
other is an live vaccine which is given orally (Sabin vaccine).The
features of the two vaccines are as follows:
125. What is Pulse Polio programme?
A. The pulse polio programme is an initiative for eradication of polio
from all the endemic areas.Under this programe, in addition to
the routine
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43
primary immunization with OPV given in earlyinfancy, 3 doses are
given to all children < 5 yearsof age at monthly intervals all over the
countryon the same days–these days are called the National
Immunization days.
126. What is the Lepromin Test?
A. This test detects cell mediated immunity. Itsimply measures the
individual susceptibility or resistance. It does not indicate past or
presentinfection. Lepromin positivity is associated withresistance to
leprosy infection. After intrademalinjection of 0.1 ml of lepromin
antigen, two typesof reactions can be seen. These are referred to asthe
early (Fernandez), which is read at 48 hoursand the late (Mitsuda)
reaction, which is read at21 days. The early reaction comprises of
rednessand induration and is regarded as positive if thearea of redness
is greater than 10 mm at 48 hours.The late reaction consists of a
papule or nodule,which is first measured after 2 weeks, and then
at weekly intervals.
127. What is the Indian classification of Leprosy?
A. In the Indian classification, leprosy is categorizedinto one of five
categories. These areindeterminate leprosy, tuberculoid leprosy,
pureneuritic, border-line lepromatous andlepromatous. The first three
categories fall under paucibacillary leprosy while the last two
fallunder multi-bacillary leprosy.
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128. What is the rationale for MDT in Leprosy?
A. MDT in leprosy is very useful because of thefollowing reasons:1.
To interrupt transmission of the infection in thecommunity as rapidly
as possible using acombination of bactericidal drugs.2. It provides an
opportunity for cure3. It helps to prevent drug resistance.4. A shorter
course of therapy ensures a better compliance5. There is reduced
work load on the health-caredelivery system.
129. What is paucibacillary leprosy?
A. In this type of leprosy, there are few bacilli in theskin wounds and
secretions and therefore suchcases are of low infectivity.
130. What is multibacillary leprosy?
A. In multibacillary leprosy, the secretions andwounds are teeming
with bacilli and these patients are therefore very infectious. Lesions
inthese patients progress much faster.
131. What is bacteriological index?
A. This index denotes change in the number of leprosy bacilli present
in the tissues. Smears aremade from at least 7 sites, including
a nasalsmear, both earlobes and 4 skin lesions. Eachsmear is graded
separately. If there are no bacilli,a score of ‘0’ is given while if bacilli
are found insome fields (mean < 1 bacilli per field), it is scoredas ‘1’;
If bacilli are found in all fields it is scoredas ‘2’ and if many bacilli
are found in all fields it
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45
is scored as ‘3’. All scores of all smears are addedand a mean
calculated. If the index is < 2, it is paucibacillary leprosy and if it is >
2 it isclassified as multibacillary leprosy.
132. What is morphological index?
A. This index is the percentage of solid rods among200 organisms
counted in a smear stained for demonstrating M. leprae. Solid rods
represent theviable bacilli. This index changes more rapidlythan the
bacteriological Index. If it shows a riseafter an initial decline, it could
indicate either

inadequate drug intake or development of drugresistance.

133. What is the recommended treatment for multibacillaryleprosy?
A. The regimen recommended by WHO consists of the following: –
Rifampicin: 600 mg once every week as asupervised dose. –
Clofazimine: 300 mg once every 4 weeks under supervision + an
unsupervised dose of 50 mgdaily. – Dapsone: 100 mg unsupervised
every day.Treatment s continues for a minimum of 2 yearsand until
the smears become negative after that.
134. What are leprosy control units?
A. These are established in endemic zones with a prevalence rate of 5
per 1000 and above and cover a rural population of 4-5 lakhs. There is
a centralleprosy clinic at the headquarters.
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135. What are SET centers under NLEP and what aretheir functions?
A. SET stands for survey, education and training andthese are the
main functions of these centers. Theseare established in endemic
zones where prevalencerate is < 5 per 1000. Leprosy paramedical
workerstrained in physiotherapy, health education andtreatment are
posted in these centers and theyfunction under the MO in charge of
the PHC. Thefunctions of these centers are:a. Detection of early cases
based on a house-tohousesurvey. b. Health educationc. Free treatment
of all casesd. Contact tracinge. Chemoprophylaxis of contacts
136. What are STDs?
A. STDs are diseases in which sex plays an important part in
transmission. They include the fiveclassical diseases–syphilis,
gonorrhea, chancroid,LGV and granuloma inguinale and
additionalconditions like non gonococcal urtheritis,
herpes progenitalis, genital warts, trichomoniasis andmoniliasis. In
addition, some diseases wheresexual transmission is possible but not
epidemiologicallyimportant are also considered as STDs.These
include genital scabies, hepatitis B, genital pediculosis and genital
molluscum contagisum.
137. What is contact tracing?
A. Sexual partners of STDs cases (also calledconjugal partners) must
be located, examined and
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47
treated. This helps in arresting the transmission

of disease. This process of identifying andfollowing up the contacts is

called contact tracing.

138. What is partner notification?

A. All cases of STDs are asked to name all their sexual partners from
whom they could have contactedthe disease or to whom they could
havetransmitted the disease. This process of identifyingthe sexual
partners is called partner notification.
139. What is the incubation period of gonorrhea andhow is the disease
spread?
A. The incubation period of gonorrhea is 2-7 days.It is primarily
spread by sexual intercourse. Thechance of contracting gonorrhea
after a singleexposure is 20-35% for men and probably doublefor
women.
140. What is AIDS and how is it caused?
A. AIDS is Acquired Immunodeficiency Syndromeand is caused by
a retrovirus called HumanImmunodeficiency Virus. The different
routes of transmission of this communicable disease are:a. Sexual
transmission – both hetero- and homosexual. b. Transfusion of
infected bloodc. Sharing needles and syringes by intravenousdrug
users.d. Transpalcental – during pregnancye. Through breastfeeding
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141. When was the National AIDS ControlProgramme initiated and what
activities areundertaken?
A. The National AIDS Control Programme startedin 1992 and has
multifaceted activities. The major component activities under the
program are:a. Modernizing blood banks to ensure safe
bloodtransfusion b. IEC to increase awareness and motivate peopleto
practice safe sexc. Sentinel surveillanced. Condom programminge.
Strengthening of STD servicesf. Training of different categories of
personnelg. Provide care and support to persons afflictedwith HIV/
AIDSh. Ensuring human rights and dignity of peopleliving with
HIV/AIDSi. Operational Research j. Prevention of Mother to Child
Transmissionk. Identification and support to NGOs to mounttargeted
interventions in high risk and bridge populations.
142. Which are the high prevalence states for HIV inIndia?
A. There are six high prevalence States in India.These are Andhra
Pradesh, Maharashtra,

Tamilnadu, Karnataka, Nagaland and Manipur.

143. What is sentinel surveillance for HIV/AIDS?
A. Every year specified number of patientsattending selected STD
clinics and antenatalclinics in all States and high risk populations like
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49
men having sex with men and Injecting DrugUsers are screened for
HIV. These figures,especially from the antenatal clinics, are used
tocategorize the country into high and low prevalence. States with
median prevalence > 1%among antenatal women are classified as the
high prevalence States.
144. What are behavioral surveillance surveys?
A. HIV/ AIDS, like some other diseases, is closelyrelated to human
behavior and thereforemonitoring of trends in behavior related to
sexual practices helps in identifying which communitiesneed priority
attention. Such surveys are calledBehavioral Surveillance Surveys.
145. What is the PMTCT programme?
A. The Prevention of Mother to Child Transmissionis an important
component of the National AIDSControl Program. All district
hospitals in the high prevalence States and all Medical Colleges in
thelow prevalence States are to be initially coveredunder this
program. All antenatal mothers areoffered voluntary testing for HIV
and those whoare positive are given a course of antiretroviraldrugs
during pregnancy to prevent transmissionfrom an infected mother to
the unborn child.Ultimately, it is proposed to cover all
districthospitals in the country.
146. What are the most common modes of transmission of HIV in India?
A. The most common mode of transmission of HIVin India is through
hetero-sexual route. The other
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important routes are through blood transfusion,injecting drug use and
mother-to-childtransmission.
147. What is Microfilaria rate?
A. The number of persons whose peripheral bloodsmear shows
microfilaria for every 100 suchindividuals tested is called the
Microfialria rate.In routine surveys, 5-7% of the population
isexamined while in evaluation surveys 20% of the population is
screened.
148. How is filariasis transmitted?
A. Mosquito bites are the principal mode of transmission of filariasis.
Transmission isremarkably inefficient. In an endemic area,
about100,000 mosquito bites are required annually to

produce one new case of filariasis.

149. How can an epidemic of dengue fever becontrolled?
A. Mosquito control measures aimed at preventing breeding, killing
of larvae and adults andavoiding mosquito bites is essential. The
infected person should be confined to the house and keptin a mosquito
net if possible to prevent transmissionof infection during the first five
dayswhen the person is infective. Health education to protect
themselves against mosquito bites isimportant.
150. What species are the primary hosts in Japaneseencephalitis?
A. Pigs and birds are primary hosts of Japaneseencephalitis. The
infection in man is a dead endinfection

Communicable Diseases
51
151. Why does JE spread to man?
A. The major reasons which prompt the spread of JE to man are as
follows:a. Relative abundance of vectors. b. Density and absolute
number of infectedmosquitoes.c. Adequate man-mosquito contact.d.
Longevity of the vector.e. Adoption of extensive paddy cultivationf.
Establishment of large modern piggeries.g. Climatic factors.h.
Presence of amplifying hosts.
152. Why is JE vaccine not very useful in controllingan epidemic?
A. The usefulness of JE vaccine in controlling anepidemic is limited
because of the followingreasons:a. Requirement of multiple doses to
attainimmunity. b. Time lag required for developing immunityc. Need
to have 80-90% coverage of the populationto control an epidemic.
153. What is the incubation period of plague?
A. The incubation period of plague is 3-4 days.
154. Which form of human plague is infectious andwhy?
A. Pneumonic plague is infectious and isresponsible for man-to-man
spread. Other formsof plague are only transmitted through bite of arat
flea which is infective for a few months under suitable conditions.
Man-to-man transmission can
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also sometimes occur when a person comes incontact with suppurated
bubos.
155. What steps should be taken to control an epidemic of plague?

A. The following steps should be followed for control of plague in man:a.

Notification: Continuous surveillance of humanand rat plague and its immediate
notification. b. Isolation in cases of pneumonic plague.c. Suspected contacts
should be quarantined for 6days. This also applies to vessels and planescoming
from plague infected areas.d. All unusual rat falls should be investigated
anddead rats should be dissected for microscopicevidence of plague.e. Prompt
treatment with antibiotics likestreptomycin, chloramphenicol, etc. should
beinstituted.f. Chemoprophylaxis should be instituted for contacts.g. Adequate
disinfection measures should beinstituted. Safe disposal of sputum and
proper boiling of patient’s clothes should beundertaken.h. Insecticidal spraying
of affected areas.i. Rat burrows should be treated with DDT. j. Mass inoculation
with plague vaccine.k. Health education measures.l. Information to WHO on a
day-to-day basis.
156. What are the arboviral diseases seen in India?
A. More than 40 arboviral diseases are seen in India.Common arboviral diseases
seen in India include:
Communicable Diseases
53
– JE – Dengue – Dengue hemorrhagic fever – Kyasunur forest disease –
Sandfly fever
157. How is epidemic typhus transmitted?
A. The body louse or head louse becomes infected3 days after sucking the
blood of a typhus patient.Infection enters the human host when crushedlouse or
its feces are rubbed on the skin,especially over a wound or a scratch.
Inhalationof louse feces or dust may account for someinfections. Conjunctival
transmission may alsooccur.
158. What is the causative organism for rabies andwhat is its incubation period?
A. Rabies is caused by Lyssavirus type 1, aneurotropic virus belonging to the
family of Rhabdoviruses. The incubation period is usually between 2-8 weeks.
159. What should you do when a patient comes witha history of a dog bite by an
unknown dog?
A. After being bitten by any unknown animal thefollowing steps should be
undertaken:

a. Exact wound should be carefully examined. Itshould be seen whether there

are true bite markson the skin or whether the clothes prevented a bite. If the bite
has not penetrated through theclothes, vaccine is not necessary. b. Local
treatment: Should be washed thoroughlywith water and 20% soap solution. It
should then be washed with savlon.
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c. Topical application and infiltration of 5 mlhyperimmmune antirabies serum
or gammaglobulin should be done.d. Wounds should not be sutured. If sutures
areessential, loose sutures should be applied.e. Anti-tetanus serum or a booster
dose of TTshould be given if the person gives a history of previous
immunization.f. Antirabies vaccine should be instituted.
160. What are the different types of antirabiesvaccines?
A. The different types of antirabies vaccines are asfollows:a. Nerve tissue
vaccines: Semple’s vaccine, etc. b. Avian embryo vaccine: Chick or duck
embryovaccinesc. Primary cell culture vaccines: Human diploidcell vaccine.
161. What is the schedule for Purified Chick embryocell culture vaccine?
A. The dosage depends on whether it is preexposure or post exposure
prophylaxis. For preexposure prophylaxis, 3 doses are given atweekly intervals
followed by a 4th dose 1-3months after the last primary dose. A booster
isrepeated every 2 years. For post exposure prophylaxis, the vaccine is given on
days 0, 3, 7,14, 30 and 90 days after exposure.
162. How is Antirabies serum given after a dog bite?
A. In all severe bites (Class III), serum should bestarted immediately. This is
done by antirabies
Communicable Diseases
55
serum or rabies immune globulin(RIG). The doseis 20 i.u. per Kg body weight
(RIG) and 40 i.u. per Kg. Body weight if it is animal serum. This isgiven as a
single dose. If the patient is seen within24 hours, part of the dose should be
infiltratedlocally and the rest given intramuscularly.
163. What is pre-exposure prophylaxis in Rabies?
A. Pre-exposure prophylaxis is given in cases of persons who are at high risk
of infection such asdog catchers, veterinary personnel and labworkers. Three
doses of Purified embryo vaccinesor Human Diploid Cell vaccines are used.
Semple

vaccine should not be used for pre-exposure prophylaxis because of the risk of
side effects.
164. What is Anthrax and how is it transmitted?
A. Anthrax is primarily a disease of animals andoccurs in man in 3 forms:
Cutaneous form (in hidehandlers), pulmonary form (wool sorters disease)and
intestinal form. Pulmonary form can alsooccur by inhalation of anthrax spores
and this isalso used as a method of biological warfare.
165. What measures should be taken to preventtetanus after a person comes with a
road trafficaccident?
A. Road traffic accidents cause dirty wounds whichhave a potential to be
infected with tetanusspores. Therefore, aggressive treatment isnecessary to
prevent tetanus. The following stepsshould be undertaken immediately:
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a. The wound should be thoroughly washed with plenty of water to wash the
spores away. If necessary, debrediment should be done under asepsis. b. If the
wound is severe or if there is a compoundfracture, tetanus antiserum should
beadministered. Tetanus Immune Globulin issafer. It should, however, be given
as soon as possible and not later than 24 hours after theinjury. If TIG is not
available, equine ATS can be given, but this can lead to hypersensitivity.Its use
should therefore not be done routinelyfor every road traffic accident.c. A
booster dose of tetanus toxoid givesimmediate protection if there is a
previoushistory of completed immunization. Otherwise,a primary course of
immunization should beinitiated.d. Secondary infection is common after
suchinjuries. Therefore, antibiotic cover to preventsuch infections should be
started.
Non Communicable Diseases
57
4
Non-communicableDiseases
166. What are the major non-communicable diseasesseen in India?
A. The major non-communicable diseases seen in

India are cancers, hypertension, coronary arterialdisease, diabetes, blindness,

depression, psychosomaticdisorders, accidents and addiction(including smoking
and alcoholism).
167. How does the epidemiology of noncommunicablediseases differ from
commoncommunicable diseases in India?
A. The differences between communicable and noncommunicablediseases in
India, in general, areas follows:a. Most of the non-communicable diseases in
Indiaaffect the middle-aged and aged populationswhile communicable disease
affect all agegroups.
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b. Most non-communicable diseases are more prevalent in urban areasc.
Lifestyle and habits are important etiologicalfactors for many non-
communicable diseases inIndia.d. Most non-communicable diseases in India
arechronic onset diseases.
168. How is blindness defined?
A. Blindness can be defined in two ways:a. As defined by the National Program
for Controlof Blindness in India b. As defined by the WHO.The National
Program defines a person as blindif he/ she cannot see the top line of the
Snellen’schart (or fingers) clearly, from a distance of 6metres, with both the
eyes tested independently,or if the field of vision is reduced to < 20
degreesaround central fixation.The WHO defines a person as blind if the topline
of the Snellen’s chart cannot be read from adistance of 3 metres or if the field
of vision is <10 degrees around central fixation.For estimating the prevalence of
blindness atcommunity level, generally the field of vision isnot
considered.Though theoretically best corrected visionshould be considered,
since this is generally not possible in a survey, presenting vision (visionwith
glasses if a person is routinely using thesame or without glasses if a person is
not wearingglasses regularly) is considered.
Non Communicable Diseases
59
169. What are the common causes of blindness inIndia?
A. The most common cause of blindness in India iscataract. Surveys in the
country show that cataractis responsible for 55-80% of blindness in India.
Theother important causes are uncorrected refractive

errors, glaucoma, corneal scars (includingtrachoma) and childhood blindness

(due to vitaminA deficiency, measles, congenital causes,retinopathy of
prematurity, etc.).
170. What is avoidable blindness?
A. Blindness which is either curable (treatable) or preventable is called
avoidable blindness as itcan be completely avoided.
171. What are the most common cancers among malesin India?
A. Cancers of the stomach, rectum, colon, esophagusand oral cavity are the
most common cancersamong males in India.
172. What are the most common cancers amongfemales in India?
A. Cancers of the uterus (including cervical cancers)and breast are the most
common cancers amongwomen in India.
173. What are the components of the National CancerControl Programme?
A. The National Cancer Control Program has thefollowing components:a.
Control of tobacco related cancers using a primary prevention approach. This
also includeseffective anti-tobacco control measures.
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b. Early detection, diagnosis and treatment of cervical and oral cancers.c.
Augmentation of therapeutic facilities.d. Researche. Evaluation of the strategies
adopted under the program.
174. What is a Cancer Registry?
A. A cancer registry is a facility which records allcancer cases occurring in a
specified area. Thereare two types of registries–the hospital based andthe
population based-registries. The hospital based-registries maintain a live
register of allcases diagnosed in hospitals treating cancers ina defined catchment
area. The population basedregistriesrecord all cases within a
specifiedgeographic area and also undertake follow-upactivities to provide
information on mortality andsurvival patterns in different cancers. Under
the National Cancer Registry Project both hospitaland population-based-
registries have been setup.The first registry was se up at Mumbai.
Registrieshave been subsequently setup at Bangalore,Chennai,
Tiruvanathapuram, Delhi and Bhopal.
175. How does hardness of water affectcardiovascular system?
A. Hard water is hypothesized to protect againstIschemic Heart Disease. Such
water tends to havea higher content of nitrate, carbonate, calcium and

silica and these elements are postulated to havea protective effect

Family Welfare
176. What is the difference between family planningand family welfare?
A. Family planning refers to a gamut of activitiesthat are intended to avoid
unwanted births, bringabout wanted births, regulate intervals between births and
to determine number of children in afamily. As against this, family welfare
refers to acomprehensive package of services which inaddition to all elements
of family planning alsoincludes activities directed towards child survivallike
immunization, reduction of low birth weight,safe deliveries, etc. simply,
put, family welfareis FP + MCH .
177. What are barrier methods of contraception?
A. Barrier methods of contraception are thosemethods which act as a physical
or chemical barrier and prevent the sperm from reaching theovum. These
include condoms, diaphragms,foam tablets, jellies, creams,
suppositories,soluble films and vaginal sponges.
178. What is a mini pill?
A. The mini pill contains only progestin and no
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estrogen as in a combined pill. The progestinmakes the cervical mucus thick
and impenetrableto sperm and induces a thin atrophic endometrium.These pills
are taken continuously.
179. What is a combined pill?
A. These pills contain a mixture of estrogen and progestin in concentration
which are physiologicallycompatible. This is the most commontype of pills
used nowadays. Sequential pillswere used earlier where estrogen alone was
givenin the first half of the cycle and estrogen and preogestin in the second half.
Nowadays both aregiven together for 21 days (with a placebo for theremaining
period of the month). The first time itis started on the 5th day of the cycle
andcontinued for 21 days.Estrogen is a powerful inhibitor of ovulationwhile
progesterones mainly regulate menstruation by acting on the endometrium.
180. What are the side effects of oral contraceptives?
A. The mian side effects include:

a. Headache b. Nauseac. Vomitingd. Breast tendernesse. Weight gainf. Inter

period spottingOther side effects include:g. Increased risk of cardiovascular
disease.h. Hypertensioni. Increased risk of gall bladder disease
Family Welfare
63
j. Decreased quantity of breast milk.
181. What is mini lap tubal ligation?
A. In this procedure tubal ligation is done througha very small abdominal
incision. Laparoscopictubal ligation by the trans-abdominal route isnow popular
as recovery is very fast.
182. What is Non Scalpel Vasectomy?
A. This is a new method of male sterilization which iscurrently being actively
promoted by the WHO.The procedure uses a fixation clamp which is usedto
grasp the vas deferens from outside the scrotalskin and a vas dissecting clamp
which is used tomake a puncture into the skin overlying the fixedvas. At the end
of the procedure, sutures are notneeded and the small puncture hole is covered
bya small piece of gauze. This method is superior toconventional vasectomy
because of:a. It eliminates the fear of a big surgical incision b. It is much
quicker to performc. It has fewer complications
183. What is the failure rate of different contraceptives?
A. Failure rate is defined as the number of pregnancies per 100 users in the first
year of typical(regular use). The failure rate for differentcontraceptives are as
follows:Contraceptive Failure rateCombined pills 1-8Mini pills 3-10Injectable
contraceptives <= 1Contraceptive implants 0 – 2
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IUD < 1Tubal ligation 0.2 – 1Vasectomy 0.15 – 1Condom 5 – 20Diaphragm 5 –
25Spermicidal jellies/creams 10 – 30Sexual abstinence 10 – 30Coitus
interruptus 5 – 25
184. What are spermicides?
A. Spermicides are barrier contraceptives which killor immobilize sperms on
contact. Used alone,

they have a high failure rate. The failure rate can be reduced by combining the
spermicides withother barrier methods like a condom.

185. What is Copper T?

A. Copper T is a second generation Intra Uterinedevice. Copper T –
200, in which the surface areaof copper is 200 sq. mm, is in common
use inmost developing countries. It has to be replacedevery 2-3 years.
186. What is the mode of action of an IUD?
A. The exact mechanism of action of IUD is still notclear. The ways
in which it acts include:a. Act as a foreign body in the uterus b. Cause
cellular and biochemical changes in theendometrium and the uterine
fluidsc. Lead to changes which reduce the viability of the ovum and
chance of its fertilization
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65
d. Copper ions impair sperm motility and viability.
187. What are the most common complications of anIUD?
A. The most common complications include:a. Bleeding which may
be midcycle or intermenstrual bleeding, greater volume of flow
andlonger menstrual periods b. Pain which is the second most
common complicationafter bleeding. This may be manifestedas low
backache, abdominal cramps or paindown the thighsc. Expulsion in 5-
15% casesd. Pelvic infection: This is 2-8 times commoner inwomen
with an IUDe. Perforation of uterus in 0.3%f. Failure leading to
pregnancy in 2 per 100 womenyears of exposure.
188. What are injectable contraceptives?
A. Injectable contraceptives are one of the mosteffective reversible
contraceptives. They containsynthetic progestins and are administered
onceevery 3 months. Two preparations are available – DMPA
(Depomedroxy progesterone acetate)and NET-EN (Nor ethindrone
enanthate). DMPAhas been used more commonly.
189. What is Depo Provera and how does it act?
A. Depo Provera is DMPA (Depomedroxy progesteroneacetate), an
injectable contraceptive. It prevents pregnancy by suppressing
ovulation,inducing a thin atrophic endometrium andcausing thick
cervical mucus which is impene
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trable to sperms.150 mg. is given every 3 months.
190. What is the MTP Act?
A. The MTP Act refers to the Medical Termination

of Pregnancy Act which was passed by Parliamentin 1971.Under this

Act, the considerationsfor termination of pregnancy include:a.
Therapeutic when the continuation of the pregnancy endangers the
life of the woman b. Eugenic when there is a risk of the child
being born with serious physical or mental handicap.c. Humanitarian
when pregnancy has been caused by raped. Social when pregnancy
has resulted fromcontraceptive failure or there is a risk to
the other due to environmental conditions.Pregnancy can only be
terminated by aqualified registered medical practitioner
possessing prescribed experience after obtainingwritten consent from
the woman. If the periodof pregnancy is between 12-20 weeks
twodoctors must concur that there is an indication.The law does not
permit MTP beyond 20 weeks.
191. What are conventional contraceptives?
A. Contraceptives needing action at or just prior tothe intercourse are
called conventional contraceptives.Physical and chemical barrier
contraceptivesgenerally belong to this category.
192. What are the major gains of the National FamilyWelfare
Programme?
A. The major gains include:a. Cafeteria approach for consumers who
can pick
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67
any method they feel is appropriate b. Lack of force or coercionc.
Improved child survivald. Reduced maternal mortality and mortalitye.
Efforts at stabilization of the populationf. Improved status of women
in societyg. Improved socioeconomic status of manyfamilies in the
country.
193. What is Equivalent Sterilization?
A. This is an index of overall family planning performancecalculated
by adding the number of sterilizations performed over a period of
time, onethird the number of IUD insertions, one eighteenththe
number of conventional contraceptive usersand one ninth the number
of oral contraceptiveusers. These weights are derived from
anassessment of the number of births averted bydifferent
contraceptive methods in India.
194. What is the hospital post partum programme?
A. The all India hospital post partum programmewas initiated in
1969. It is a maternity center/hospital based approach to family
welfare. Therationale of the program is as follows:a. Women who
have recently delivered are at highrisk of getting pregnant again

b. They are a captive audiencec. They are most receptive to advice on

family planning immediately after delivery.
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6
Population andDemography
195. What is demographic transition?
A. Demographic transition comprises of stagesthrough which
countries pass in their history froma situation of high birth rate and
high death rateto a situation of low birth rate and low death rate.There
are five stages in this transition:a. High stationary stage: High birth
rate and highdeath rate b. Early expanding: High birth rate but
decliningdeath ratec. Late expanding: Birth rate starts declining
whiledeath rate declines much faster d. Low stationary: Stable
population characterized by low birth and death ratese. Declining:
Birth rate is lower than the death rate
196. What is the population of India?
A. The population of India as per the 2001 census isrightly above one
billion.
Population and Demography
69
197. What are the causes for population explosion inIndia?
A. The causes for population explosion in India are:a. Marginal
reduction in birth rate as against asteep decline in death rates b. High
Infant mortality and child mortality leadscouples to have larger
families to ensuresurvival of a fewc. Preference for a male child leads
to a number of children being born in the quest for a male childd.
Need of more hands to work in the farms toconserve resources within
the familiese. Young age at marriagef. Early onset of procreationg.
Acceptance of child birth as God’s gifth. Poor literacy and economic
status
198. What is growth rate?
A. Growth rate is the net difference between thecrude birth and death
rate in any country. It tellsus how many more people are being added
to

the population every year.

199. What is negative growth? Name some countrieswhich show negative

growth rate in the world
A. When the birth rate falls below the death rate,there is no addition
to the population but only adecrease of the population. Such a
situation iscalled negative growth rate. Many Scandinaviancountries
and other countries in Western Europehave entered into the last
stage of thedemographic transition. Sweden and Hungaryare
examples of such countries.
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200. What is Net Reproduction Rate?
A. Net Reproduction Rate is defined as the averagenumber of
daughters that would be born to awoman if she experiences
the current fertility andmortality patterns throughout her
reproductivespan (15-49 years). The target for India is an NRR of 1
which means that 1 daughter will replace her mother. This will enable
population stabilizationto occur.
201. How is Crude Birth rate defined? What is thecurrent Crude Birth
Rate in India?
A. Crude birth rate refers to the number of live birthswhich occurred
in the population of a givengeographic area during a given year
among themid-year total population of the same areaduring the same
period. It is expressed as per 1000 population. The crude birth rate in
India is25 per 1000 population.
202. What is sex ratio?
A. The number of females per 1000 males is calledthe sex ratio.
Biologically, female of the speciesis stronger and has a higher life
expectancy andtherefore there should be more females per 1000males.
In India the sex ratio is 933 females per 1000 males which is an
adverse sex ratio andindicates discrimination agonist women.
OnlyKerala has more females per 1000 males in thecountry.
203. What is life expectancy at birth in India?
A. The life expectancy at birth in India currently is64 years.
Population and Demography
71
204. What is the current crude death rate in India?
A. The crude death rate in India is 9 per 1000 population
205. What are the salient features of the NationalPopulation Policy?
A. The salient features of the National PopulationPolicy are:a. MCH
and Family Planning services standmerged with health.

b. No targets for specific contraceptive methods.c. The only target

will be achievement of nationalaverage of Total Fertility Rate of 2.1
by the year 2010.d. Incentives for family planning acceptors to
bediscontinued.e. NGO involvement in the programme promoted.f.
IEC activities to be implementedg. Reduction in the incidence of girls
below 18getting married to zero.h. Increase in percentage of
deliveries conducted by trained personnel.i. Reduction of maternal
mortality rate to < 100 per 100,000 live births. j. Universal
immunization.k. Reduction of IMR to < 30 per 1000 and a
sharpdecline in Child Mortality Rate.l Universal access to quality
contraceptiveservices.m. Containment of HIV/AIDS and STDs.
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7
Health CareAdministration
206. What is a policy and how does it differ from aplan or programme?
A. Policy refers to the statement of intent i.e. whatdoes the
government intend to do or what is thegeneral direction in which the
country shouldmove. A program refers to the sequence of activities
designed to implement a plan. A planis the composite total of all
objectives, strategiesand monitoring tools that is meant to produce
adesirable result.
207. What is the difference between goal andobjective?
A. Goals are the ultimate aim of any program – Theideal for which
one strives. They may not always be achievable but they shine like a
beacon lightand allow one to chart a course of action to reachthe goal.
An objective is more realistic and
Health Care Administration
73
quantifies what output is desirable at the end of a specific time
duration. Thus objectives alwayshave an end point and have a
dimension of time.
208. What is Effectiveness?

A. Effectiveness is the quantum of change that has been brought

about by an activity as comparedto the change desired during a
specific time period. How much has been achieved (or magnitude
reduced) out of what was desired to be achieved is called
effectiveness. It is like amilestone on the highway which tells us how
for we have covered on our journey towardsachieving what we set out
to do.
209. What is Efficiency?
A. Efficiency denotes the ratio of output to inputs.Efficiency is
dependent on output and theresources (including time and money)
that wereexpended in achieving an impact. The totaloutput that has
been achieved divided by the cost(or other resources) incurred in
undertaking theactivity is defined as efficiency.
210. What is the difference between cost benefit andcost effectiveness?
A. In cost benefit analysis, the monetary value(financial value) of the
benefits accruing from aspecific activity and the cost that has
beenincurred in undertaking the activity areconsidered. Therefore,
both the cost and the benefit are weighed in monetary terms.
Asagainst this, in cost effectiveness analysis, moneyincurred in
undertaking an activity is costed while
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the effectiveness of the intervention is measuredin non-financial terms
(no. of deaths averted, no.of children protected against measles, etc.).
Thisis more popular in health as the effectiveness of all interventions
in the health sector cannot bemeasured in financial terms.
211. What are five year plans?
A. For socio-economic development of the countrywithin a short time
perspective, the Governmentallocates resources for a five-year period.
Specificobjectives and measurable outputs are set upwhich have to be
achieved by the resources provided for the same. The Planning
Commissionwas set up in 1950 for the purpose of appropriate
planning for India’s developmentwithin the resources available. Five-
year developmental plans were drafted for the first time in1950-51.
The Ninth Plan was completed in 2002and the Tenth plan is currently
under way from2002-2003.
212. What is Minimum Needs Programme?
A. The Minimum Needs Programme is the main plank for
developmental plans in the country.This includes a set of activities
which are neededto be implemented to bring about a change inthe
country. The different components of the

MNP include:a. Rural Health b. Rural Water supplyc. Nutritiond.

Elementary education
Health Care Administration
75
e. Adult educationf. Housing for landless laborersg. Environmental
improvement of slumsh. Rural electrification
213. What was Bhore Committee?
A. This Committee, also known as the Health Surveyand
Development Committee, was set up in 1943under the Chairmanship
of Sir Joseph Bhore for structuring of the health services in the
country.It laid emphasis on integration of curative and preventive
medicine at all levels and recommendeda network of primary health
centers.
214. What was the Mudaliar Committee?
A. The Mudaliar Committee was known as heHealth Survey and
Planning Committee and wasset up in 1962 to assess the performance
of thehealth sector since the submission of the BhoreCommittee
report. The Committee suggestedstrengthening of the existing PHCs
before newPHCs were opened. Strengthening the subdivisionaland
district hospitals was also advised.
215. What was the Kartar Singh Committee?
A. This committee was also called the committee onmultipurpose
workers under Health and FamilyPlanning. It was constituted to form
a framework for integration of health and medical services
at peripheral and supervisory levels.
216. What is the ROME scheme?
A. The Reorientation of Medical Education schemewas launched in
1975 to determine the stepsneeded to reorient medical education in
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accordance with national needs and priorities.The recommendations
for the same were made by the Shrivastava Committee.
217. What is the doctor population ratio in India?
A. The doctor; population ratio in India is 1: 3500.
218. What subjects are covered under the Concurrentlist in India?
A. The subjects covered under the Concurrent listare:a. Inter-state
spread of disease b. Prevention of food adulterationc. Control of drugs
and poisonsd. Vital statisticse. Labour welfaref. Minor ports
g. Population control and family planningh. Social and economic
planning
219. What is the Physical Quality of Life Index?
A. Three elements together constitute the PhysicalQuality of Life
Index (PQLI):a. Infant mortality rate b. Life expectancy at birthc.
Literacy rateA. PQLI is used to grade the quality of life indifferent
countries of the world.
220. How is the poverty line defined in India?
A. The poverty in India is defined as the amount of money required to
provide for a diet of 2400calories in the rural area and the families
whocannot afford this amount of money to spend onfood are said to
be below the poverty line.
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77
221. What is DALY?
A. DALY is an abbreviation for Disability AdjustedLife Years and is
used to measure the durationof life which is free of any disability.
Thistherefore denotes what proportion of our population leads a
healthy life.
222. What are the three levels of health care in India?
A. The three levels of health care in India are:a. Primary health care:
Essential health care provided at the first level of contact of peoplewit
the general health services. b. Secondary health care: Intermediate
level of health care where specialist facilities areavailablec. Tertiary
level: Highest level of health care wheresuper specialty services are
available.
223. What are the functions of a PHC in India?
A. The functions of a PHC in India include:a. Medical care including
referral and lab services b. Control of communicable diseasesc.
Environmental sanitation and safe water supplyd. MCHe. Family
Planningf. School Health Servicesg. Health Educationh. Collection
of vital statisticsi. Implementing National Health Programs j. Training
of personnel
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224. What is the staffing pattern of a new PrimaryHealth Centre?
A. A new PHC caters to a population of 30,000 andhas the following
complement of staff:a. Medical Officer: One b. Community Health
Officer: Onec. Pharmacist: One

d. Nurse Mid wife: Onee. ANM: Onef. Health Educator: Oneg.

Health Assistant (Male): Oneh. Health Assistant (Female): Onei.
UDC: One j. LDC: Onek. Lab Technician: Onel. Driver (Subject to
availability of vehicle): Onem. Class IV: OneTotal: 16
225. What is the staffing pattern of a CHC?
A. The following staffing pattern has beenrecommended for a CHC: –
Specialists (Med, Sur, Gyn, Ped): Four – GDMO (One each
trained in anaesthesia, PublicHealth & ISM): Three – Nurses: Three –
Pharmacist: One – Lab Technician: One – X-Ray Technician: One –
Ward Attendants (Male & Female): Eight – Sweepers (Male and
Female): Eight – Driver: One – Others: Twelve
Health Care Administration
79
226. How much population is covered by a subcentreand who are the
health functionaries at thesubcentre level?
A. Each sub-centre covers a population of 5000 andeach subcenter is
manned by one male and onefemale health worker. In addition a
voluntaryworker helps the other staff at the subcenter.
227. What is the Community Health Volunteersscheme?
A. This is also called the Health Guides Scheme andis operational in
most states. The person isenvisaged as somebody from within
thecommunity and is a permanent resident of thevillage. This person
should be acceptable to allsections in the village and should have
beeneducated to at least the 6th class and be able tospend 2-3 hours
everyday on health-relatedactivities. The person is given a 3 months
trainingat the PHC and is paid an honorarium.

228. What are the major duties of a medical officer atthe PHC?
A. The major duties of the MO include: – OPD and Indoor services –
Medico-legal cases – Attending to emergencies – Organizing lab
services at PHC – Assist in referral services – Supervise all
subordinate staff

– Report preparation – Liaison with other functionaries at the

districtlevel – Managing supplies and stores.
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229. What is the trained dai scheme?
A. Under this scheme all the untrained dais whoroutinely conduct
deliveries in the villages are provided a short orientation and provided
a kitfor safe delivery. The target is to train one dai per 1000
population. The training is of a month’sduration at the local PHC.
230. What is a dai kit?
A. After training the dai is provided with a kit for safe delivery. This
includes fresh blades and cordtie. In addition, antiseptic application
for the cordstump and antibiotics for prevention of ophthalmia
neonatorum are also provided.
231. What are the significant recommendations of theKrishnan
Committee?
A. These include:a. Creation of organized health services to
urban populations where more than 40% live in slumlike
conditions. b. Creation of 4 types of health postsc. The 4 types cover
populations of 5000, 5000-10000, 10000-25000 and 25000-50000.d.
Staffing pattern is dependent on the type of facility
232. What are the components of School HealthProgramme?
A. The major components of the school health programme are:a.
Health teaching including diets, sanitation, personal hygiene and
general cleanliness b. Health education
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81
c. Maintenance of healthy school environmentincluding safe water
supply, adequate drainage,ventilation, garbage disposal, latrines
and playgrounds.d. Comprehensive student health care
including preventive, promotive, curative andrehabilitative aspects.e.
Periodic medical examination including dentaland eye examination.
233. What is Juvenile delinquency?
A. Juvenile delinquency is defined as antisocial behavior on the part
of boys and girls, less than18 years of age that is not accepted by
societyand calls for some kind of admonishment, punishment or
corrective measures. This can becaused by mental deficiency, organic
brain

disease, manifest psychiatric disorder, adversehome and social

conditions, poor inter personalrelationships within the family and
parentalrejection.
234. What are the objectives of the National MentalHealth Programme?
A. The objectives of the National Mental HealthProgram include:a.
Ensuring availability and accessibility of minimum mental health care
for all, particularlyfor the vulnerable and underprivileged sectionsof
the populations. b. Encouraging application of mental
healthknowledge in general health care and in socialdevelopment.
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c. Promote community participation in mentalhealth services.
235. What is primary health care?
A. Primary health-care has been defined by WHOas essential health
care made universallyaccessible to individuals and acceptable to
them,through their full participation and at a cost thatthe country and
community can afford. It formsan integral part of the community’s
health systemand of the overall social and economicdevelopment of
the country. It is the first level of contact for individuals with the
national healthsystem and should be accessible and affordableto all
segments of society. It enables individualswithin the community to
attain a level of healththat would allow them to earn their
livelihoodand lead a socially and economically productivelife. It is the
key to attain the goal of Health for All.
236. What are the essential elements of primaryhealth care?
A. The minimal essential elements of primary healthcare include:a.
Education concerning prevailing commonhealth problems and the
methods of preventingand controlling them b. Promotion of food
supplies and proper nutritionc. Provision of basic sanitation facilities
andadequate quantity of safe drinking water d. Maternal and child
health care including family planning
 Health Care Administration
83
e. Immunization against major infectious diseasesf. Prevention and
control of locally endemicdiseasesg. Appropriate treatment of
common ailments and

injuriesh. Provision of essential drugs

237. What is Health for All?

A. Health for All aims to provide a set of healthrelatedservices to all
individuals in society toenable them to be in positive health and free
fromdisease. Such a state will allow individuals tofunction optimally
and earn their livelihood.Access to health should be equitable and
nobodyshould be denied basic services because of their inability to
pay for their health. Community participation should be encouraged
so that populations are provided skills to take care of their own health.
Primary health care has beenidentified as the key to Health for All.
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8
Nutrition
238. What is PEM?
A. PEM is the short form for Protein Energy Malnutrition.This is a
state of nutritional deficiencywhere both energy and protein needs of
the bodyare not met sufficiently by the available dietaryintake. This is
the commonest form of malnutrition found in India and other
countries.Its incidence is highest in childhood. Childrenhaving weight
for age less than 60% of thestandard are severely malnourished.
Prevalenceof severe malnutrition in preschool children isabout 5% in
India.
239. Which type of PEM do we see more commonlyin India
A. Mild malnutrition [weight below 80% of thereference weight for
age] and moderatemalnutrition [weight below 70% of the
referenceweight for age] are more common than severePEM which is
defined as weight below 60% of
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85
the reference weight for age. The general trendin nutritional status
surveys of preschoolchildren in India is that about 20% are
normal,40% have mild or grade I malnutrition, 35% havemoderate or
grade II malnutrition, while 5% havesevere or grade III malnutrition.
240. What is the difference between Marasmus andKwashiorkor?
A. Marasmus is pure energy deficiency without protein deficiency.
Kwashiorkor is pure protein

deficiency while energy intake is adequate. Boththese forms of

malnutrition are much lesscommon than PEM. Marasmus presents as
thin,skinny emaciated child with hanging skin folds,head apparently
larger than the thin body, givinga wizened [like a wise person]
appearance to thechild. Marasmus typically presents as swollen body,
edematous limbs, moon face anddiscoloured, hypopigmented hair.
Kwashiorkor has become rather rare now-a-days.
241. How will you manage a child with PEM?
A. The best treatment for a child with PEM is toincrease his food
intake by whatever means. Nospecific dietary regimen is necessary as
long assufficient amount of hygienic ordinary food isgiven. For this
purpose, two important points arefeeding frequency and energy
density. Feedingfrequency of a malnourished child has to beincreased
so that something is given to him for eating every 3-4 hours. Increase
in energy densitycan be achieved by giving more fat to the child. It
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is important to remember that no special effortsare needed to increase
protein intake. Globaldietary surveys have shown that diets all
over the world contain sufficient protein to take careof body needs as
long as sufficient food is eatento fulfil the energy needs.
242. What are nutritional deficiency diseases? Namesome common
nutritional deficiency diseases inIndia and how they can be controlled?
A. The four common nutritional deficiencies of public health
importance are protein-energydeficiency, iron deficiency, iodine
deficiency andvitamin A deficiency. Control of PEM basicallylies in
ensuring adequate food intake by thechild, for which nutrition
education and increasingfood purchasing power [decreasing
poverty]are key approaches. Control of iron deficiencylies in nutrition
education aimed at increasingintake of iron rich foods, especially
leafyvegetables, and giving iron supplements. Controlof iodine
deficiency essentially lies in ensuringuniversal intake of iodized salt.
Control of vitamin A deficiency essentially lies in nutritioneducation
aimed at increasing the intake of greenleafy vegetables and other
vitamin a rich foods.The government is phasing out vitamin
Adistribution program for preschool children.
243. What are fat soluble vitamins? Name diseaseswhich result from
deficiencies of fat solublevitamins. How can you control such diseases?
A. Main fat soluble vitamins are Vitamins A,D,E andK. Out of these
only vitamin A deficiency is of

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87
public health importance. It leads toxerophthalmia, the earliest
symptom of which isnight blindness, while severe degrees
causekeratomalacia, which may, ultimately, result inloss of the eye.
Dietary sources are green leafyvegetables, yellow fruits, milk, eggs
and liver.Vitamin D deficiency as such is rare because evenin absence
of dietary intake, it can be manufacturedin body in presence of
sunlight. Dietarysources are milk, eggs and liver. Natural vitaminE
deficiency rarely occurs. This vitamin is presentin sufficient quantity
in the diet. Vegetable oilsare a good source. Vitamin K deficiency
never occurs because of deficient diet. This vitamin hasa role in blood
coagulation.
244. What is nutritional supplementation? Give someexamples
A. Nutritional supplementation means supplementingthe nutritional
intake of a person. Thiscan be done by means of diet
supplementationor specific nutrient supplementation. Generaldiet
supplementation is done to prevent or manage PEM in children. The
Integrated ChildDevelopment Services [ICDS] is the biggestdietary
supplementation program in the countryat present. The biggest
example of specificnutrient supplementation is iodization of
salt,which is being done all over the country at presentfor prevention
of iodine deficiency disorders.Other nutrient supplementation
programs arethose against iron deficiency [where iron-folicacid
tablets are given to pregnant women and
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syrup to children] and vitamin A deficiency for which vitamin A
solution is given to preschoolchildren every 6 months.
245. What is Vitamin A prophylaxis programme?
A. It was started in 1970 for prevention of vitamin Adeficiency in
children. Under this program,200,000 international units of vitamin A
are givenevery 6 months to children below 3 years of agein the form
of one teaspoonful of oily solution.Recent evaluation of the program
has suggestedthat it might be better to put more emphasis
uponnutrition education aimed at increasing dietaryintake of vitamin
A rather than on six monthlyvitamin A distribution.

247. What are essential fatty acids? Which foods arerich in essential fatty
acids?
A. Essential fatty acids are those fatty acids whichcannot be
manufactured in the body and must be supplied in diet. There
are three essential fattyacids, namely, linoleic acid, linolenic acid
andarachidonic acid. Of these, the last two can beconverted in the
body from linoleic acid. Hence,linoleic acid is the most important
EFA. The EFAsare present in adequate quantity in most dietsand,
therefore, natural deficiency of EFA isunknown. The invisible fat
present in cereals and pulses contains sufficient EFA for body needs.
248. What is the recommended daily dietary intakeof iron during
pregnancy?
A. According to the ICMR, RDA for iron is 28mg.for men, 30 mg. for
non-pregnant women and 38mg. for pregnant women. It is more in
pregnancy because iron stores needed for a healthy baby arederived
from the mother’s iron intake.
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249. Which foods are rich sources of iodine?
A. Common sources of iodine in diet are milk, meatand cereals. Some
green leaves, especiallyspinach, are also good sources. Sea fish and
other sea foods are very rich in iodine.
250. What happens in deficiency of Riboflavin?
A. Ribiflavin is concerned with biological oxidative processes and its
deficiency causes metabolic

impairment. Deficiency symptoms may be oral[angular stomatitis and

glossitis], dermal [scalydesquamation of naso-labial folds and
scrotaldermatitis] and ocular [vascularisation of cornea].
251. What are the adverse effects of folic aciddeficiency?
A. Folic acid helps in the formation of white bloodcells and in the
maturation of normoblasts into red blood cells. Its deficiency causes
megaloblasticanemia and may also lead to tropical sprue.
252. How does cow milk differ from human milk?
A. The major differences are as follws:a. Human milk has only
one third of the proteinconcentration compared to cow milk. But
whey protein, which is soluble, is present inrelatively much higher
concentration in cow’smilk, which is far richer in the insoluble
casein.Because of this difference, the curd that formsin the stomach is
much lighter and easilydigestible in case of human milk than
cowmilk. b. Human milk has slightly more fat than cowmilk. Also,
human milk contains a lipase
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91
enzyme because of which human milk fat isdigested easily.c. Human
milk has almost double the amountof lactose compared to cow milk.
Lactose provides an easily digestible source of energy.High lactose
content helps in myelination inthe growing nerve tissue of the baby.
Also, part of lactose is converted to lactic acid inthe intestine, which
prevents growth of undesirable bacteria in the intestine.d. Human
milk contains the bifidus factor, whichis a nitrogen-containing
carbohydrate. Bifidusfactor is necessary for the growth
of Lactobacillus bifidus, which converts lactoseto lactic acid.e.
Human milk, especially the colostrum,contains large amounts of
ImmunoglobulinA, which is not absorbed but acts in theintestine
against certain bacteria [such as E.coli] and viruses.f. Lysozyme, an
enzyme, is present in humanmilk in concentrations several thousand
timesthat of cow milk. Lysozyme breaks downcertain harmful
bacteria and also protectsagainst various viruses.
253. What is pasteurization?
A. Pasteurisation is a process by which milk is madefree from all
pathogens, including the tubercle bacillus, which is killed at 63
degrees Celsius. In pasteurisation, milk is heated to a temperature

above 63 degrees. This process kills pathogens but preserves most

nutrients which, on the other
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hand, are partially lost by boiling. In the Britishor holder process of
pasteurisation, milk isheated and maintained at 65.5 degrees for
half hour, then cooled to 10 degrees. In American or flash process,
milk is heated and maintained at71-72 degrees for 15 seconds, then
suddenlycooled to 10 degrees.

254. What nutrients are found in green leafyvegetables?

A. Green leafy vegetables contain the followingnutrients in significant
amounts:a. Vitamin A b. Riboflavinc. Folic acidd. Vitamin Ce.
Vitamin K f. Irong. Calcium
255. Which oils are rich in polyunsaturated fatty acids?
A. Vegetable fats are in general poluunsaturatedwhile animal fats are,
in general, saturated. Anexception is fish oils, which are
polyunsaturated.Amongst vegetable oils, those with
maximum polyunsaturated fatty acid content are corn oil,cotton seed
oil, sunflower oil and sesame oil.Groundnut oil is relatively saturated.
Coconutoil is almost saturated.
256. How can nutrient losses be minimized duringcooking?
A. Following precautions should be taken so thatnutrient loss during
cooking is minimized:
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93
a. Food should not be cooked for unnecessarilylong periods. b.
Cooking time can be reduced by the use of pressure cooker.c. Food
should not be cooked in open pans. Nutrient loss is less if the pan is
covered by alid.d. Vegetables should not be cut into too
small pieces.e. Vegetables should be washed before, notafter,
cutting.f. Baking soda should not be used because lossof vitamins is
more in alkaline medium.Addition of a little lemon juice,
tamarind,vinegar or sour curd or buttermilk makes thefood slightly
acidic and reduces vitamin loss.g. Water should not be thrown away
after boiling rice or vegetables.

h. When cooking vegetables, they should be putstraight into boiling

water. By doing so, theenzyme oxidase is destoyed. Otherwise,
thisenzyme destroys vitamin C.
257. What are the features of an Indian ReferenceMan as defined by
ICMR?
A. The reference man is aged 20-39 years and weighs60 kg. Such a
man has surface area 1.62 squaremetres and his BMR is 35.5 kcal. per
hour per metre square. The reference woman is 20-39 yearsold, and
weighs 50 kg. She has surface area 1.40sq. m. and her BMR is 31.6.
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258. What are the daily energy requirements of asedentary male worker?
A. The ICMR recommends that a sedentary maleworker should take
2425 kcal. per day. The RDAfor energy for a moderate and heavy
male worker is 2875 and 3800 kcal respectively.
259. What are the daily energy requirements of anadult female moderate
worker?
A. The RDA for energy for females is 1875 kcal. for sedentary
worker, 2225 for moderate and 2925for heavy worker.
260. What are the energy requirements of an infantaged 5 months?
A. ICMR recommends that a child aged 0-6 monthsshould take 108
kcal. per kg body weight per day.
261. What are the advantages of breast feeding?
A. The major advantage is that breast milk is tailor made for the
human infant as compared to cowmilk which is meant for the calf.
The human milk is moe easily digestible. It is clean and there isno
risk of contamination diarrhea. It is obviouslyeconomic, while other
milks are expensive andneed other things like feeding bottle and
thefacilities to keep them clean. Breast milk alsocontains anti-
infective properties and prevents thechild against infections. Children
who are breastfed have more mother-child bonding and better
psychological development.
262. What is weaning and when should it be started?
A. The term weaning is used in two ways. Correctlyspeaking,
weaning means the period from when
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95
a mother decides to stop breastfeeding till shehas achieved this.
Sometimes, weaning is usedto indicate the period from when
supplementaryfood has been introduced till breastfeeding hasceased.
As regards introduction of supplementaryfoods, solids may be
introduced around4-5 months of age. Too early supplementaryfeeding
carries the risk of diarrhea. Too late

introduction carries the risk of malnutrition .

263. How is malnutrition graded by Indian Academyof Pediatrics?
A. According to Indian Academy of Pediatrics,children having weight
upto 80% of the referenceweight for age [50
th
percentile of the Harvardstandards] are considered as normal.
Thoseweighing between 71 and 80% are classified asfirst degree
malnutrition; those weighing between 61 and 70% are classified as
seconddegree malnutrition, while those weighing between 51 and
60% are classified as third degreemalnutrition. Those weighing less
than 50% arelabelled as fourth degree malnutrition.
264. What methods can be used to collect informationon food
consumption by a family?
A. The most common and practical method is thediet history method
in which the person is askedabout the actual type and quantity of food
eatenduring past 24 hours. Further calculations aboutintake of
different nutrients can be done with thehelp of food tables. Another
method is to ask the person to keep a diet intake record in a diary for
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a few days. This record is then computed to findthe average daily
intake over the period. Thereare other methods also where the family
is askedto actually weigh the foodstuffs cooked or consumed. But
these are not practical at all andare rarely used.
265. What is the applied nutrition programme?
A. The applied nutrition program was started in 1960in Orissa and
was gradually extended to all statesin 1973. The objectives of the
program were:a. To make people conscious of their
nutritionalneeds; b. To increase production of nutritious foodsand
their consumption;c. To provide supplementary nutrition tovulnerable
groups through locally producedfoods.There were many shortcomings
in the actualimplementation of the program. With theadoption of
ICDS as a national program, theANP has almost ceased to exist.
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97
9
MCH

266. Name some immunization preventable diseases?

A. Common diseases which can be prevented byimmunization
include: – Tetanus – Poliomyelitis – Diphtheria – Whooping Cough –
Tuberculosis – Measles – Typhoid – Rubella – Mumps – Chicken
pox – Hepatitis B
267. Which immunizations are given to childrenduring first year of life?
A. The following immunizations are given tochildren during their first
year of life: – Tetanus – Poliomyelitis
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– Diphtheria – Whooping Cough – Tuberculosis – Measles
268. What is the schedule for immunization duringpregnancy?
A. Tetanus toxoid is given during pregnancy. Twodoses are to be
given for primary immunization.The first dose should be given
between 16-20weeks and the second dose between 20-24 weekswith a
month’s gap between the two doses. Sinceit takes 3 weeks for
antibodies to develop, thesecond dose should definitely be given at
least 4weeks before delivery. If a woman has beenadequately
immunized earlier she needs only a booster dose of TT, given at least
4 weeks prior to delivery.
269. What is the National Immunization Schedule?
A. The National Immunization Schedule consists of 2 doses of TT
during pregnancy, 3 doses of OPVand DPT between 6 weeks to 9
months with agap of 4-6 weeks between each dose, one dose of BCG
at birth or as early in life as possible, onedose of measles vaccine
between 9-12 months anda booster dose of OPV and DPT at 16-24
months.In addition, booster doses of DT at 5 years andTT at 10 years
and 16 years are also recommended.For hospital deliveries an
additionaldoes of OPV can be given at birth.
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99
270. Define IMR.
A. It is defined as the number of infant deaths (0-12

months) per 1000 live births in a country. It is asensitive indicator of

the level of health servicesin a country.
271. What are the common causes of IMR in India?
A. The common causes of IMR include: – Immunization preventable
diseases – Low birth weight – Acute respiratory infections – Diarrheal
dehydration – Early weaning and lack of breastfeeding – Congenital
anomalies – Birth injury – Prematurity
272. How is < 5 Mortality Rate defined?
A. The total number of deaths among children lessthan 60 months of
age per 1000 live births isdefined as Under Five Mortality Rate
273. What is Neonatal Mortality Rate?
A. This is defined as the number of deaths less than28 days of age
per 1000 live births. Most of thesedeaths occur due to prenatal or
natal causes.
274. What is Perinatal Mortality Rate?
A. This is defined as deaths of fetus after 28 weeksof gestation till the
first 7 days of post natal life per 1000 live births.
275. What is Low birth weight?
A. Low birth weight is defined as a baby weighingless than 2500
grams at birth. In India the Indian
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Academy of Pediatrics has suggested at infants born with weight less
than 2000 grams should beconsidered as low birth weight
because Indian babies are smaller. However, for all
internationalcomparisons weight less than 2500 grams isconsidered as
low birth weight
276. What are the causes of low birth weight in India?
A. The causes of LBW are maternal in origin.However, in a third the
cause is unknown. Thecommon causes are:a. Maternal malnutrition b.
Anemiac. TBd. Infections during pregnancy – Malaria, Urinarytract
infection, etc.e. Systemic maternal diseases – Hypertension, etc.f.
Multiple pregnancies
277. What do you mean by high risk approach?
A. High risk approach is applicable both to pregnantmothers and
children. The basic premise of theapproach is the use of screening
tools to identifyindividuals who are at more risk of sufferingfrom
severe morbidity or mortality and provideextra care and support to
such individuals. Inantenatal care, mothers with anemia, malnutrition,

illness elderly primi, and those withhistory of earlier bad obstetric

outcome, are highrisk mothers .

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101
278. What are the causes of maternal mortality?
A. The causes of maternal mortality can be categorizedas follows:a.
Obstetric causes: These account for more than50% of deaths –
Puerperal sepsis – PET – Hemorrhage – Rupture of uterus –
Accidents during labor b. Non-obstetric causes – Anemia – Heart
Disease – Kidney disease – Malignancies – Hypertension –
Diabetes – Jaundice – TB – Accidents ,etc.c. Social causes – Early
marriage – Early childbirth – Large no. of pregnancies – Frequent
pregnancies – Malnutrition – Poverty – Illiteracy, etc.
279. What is a high risk pregnancy?
A. A high risk pregnancy is one where the mother suffers from causes
which are detrimental to her
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health or the fetal health. Some of these importantfactors are: – PET –
Systemic diseases – Hypertension, RHD,Diabetes, Renal disease,
etc. – TB – Age over 35 years – Elderly primi – More than 5 previous
pregnancies – History of past stillbirths – History of neonatal deaths –
Previous Caesarian section – Hemorrhage – Placenta previa – Short
stature – below 150 cms – Young primi - < 16 years, etc.
280. How many visits should be made by a health

worker during pregnancy?

A. Ideally a mother should be seen once everymonth during the first 7
months and once everyfortnight during the next two months and once
aweek after 36 weeks till delivery. However, thismay not be possible
in rural areas. Therefore,under the antenatal care program, each
registeredantenatal case should receive at least fiveantenatal visits of
which one should be early in pregnancy, one should be after 36 weeks
and atleast one should be a home visit. The medicalofficer should
examine the mother at least onceduring pregnancy. Complicated and
high risk cases need more frequent visits.
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103
281. What all drugs should a pregnant mother receiveand for what
duration?
A. The mother should receive iron tablets once a dayfor three months
during the second/thirdtrimester. No medications should be given
duringthe first trimester. 100 tablets of iron + folic acidare given to all
mothers during pregnancy.
282. What is the package of services provided underICDS?
A. The package of services under ICDS are as follows:
Beneficiary ServicesExpectant and nursing – Health check-
upmothers – Tetanus Immunization – Supplementary nutrition –
Nutrition and healtheducationOther women aged – Nutrition and
health15-44 years educationChildren < one year – Supplementary
nutrition – Immunization – Health check-ups – Referral
servicesChildren aged 12 – 36 months – Supplementary nutrition –
Immunization – Health check-up – Referral servicesChildren aged 3-
5 years – Supplementary nutrition – Immunization – Health check –
Referral services – Non-formal pre-schooleducation
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283. What is the mid-day meal programme?
A. The mid-day meal program was initiated in 1962with the following
objectives: – To raise the nutritional status of primary schoolchildren,
particularly those belonging to lowsocioeconomic status – Improve
attendance and enrollment in schools – Prevent drop out from primary
school

Ready to eat food is provided to childrenattending primary school

(aged 6 – 11 years).Such food should provide 300 Kcal and 8-
12grams of protein per day for at least 200 days in a year

284. What is the cold chain and how is it maintainedat the periphery?
A. Vaccines are thermo-labile products andtherefore need to be
maintained at appropriatetemperatures from production
to distribution.The entire procedure of maintaining
the appropriatetemperatures from manufacturer to immunizationis
called the cold chain. Temperaturesshould be maintained between 2-8
degreescelsius. At the PHC level, this temperature ismaintained by
refrigerators while at the subcenter level or point of immunization this
is maintained by vaccine boxes which are lined by ice packs.The
recommended temperatures should bemaintained during
transportation also.
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105
285. What is the Reproductive and Child HealthProgramme?
A. This program has been initiated to meet thecomprehensive health
needs of the mother andchild. The activities carried out include: –
Infant care including immunization – Child care including
immunization, vitamin A prophylaxis, nutritional anemia
prophylaxis,acute respiratory infections control and diarrheacontrol. –
Antenatal care including immunization againsttetanus, anemia
prophylaxis, ante natal checkups,care at birth and birth spacing.
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10
Environment
286. What is environmental pollution?
A. This may be described as the unfavorablealteration of our
surroundings and occurs primarily due to actions of humans.
287. What diseases can be caused by environmentalpollution?
A. Many diseases can be caused by environmental pollution. These
can be categorized as follows:Air pollution – Bronchial asthma –
Pulmonary edema

– Bronchitis – Emphysema – Lung cancer Water Pollution –

Diarrhea – Cholera – Typhoid – Shigella – Amoebiasis
Environment
107
Noise pollution – Deafness – Irritability
288. What is a sanitary well?
A. A sanitary well has the following characteristics: – A pucca brick /
concrete casing – A parapet wall 0.5 – 1.0 m high with cementlining
on both sides and sloping outwards onthe top – A pucca cement
concrete platform on all sidesof well of 0.5 – 1.0 meters in dimension
andslopping towards the periphery. – A circular drain around the
platform to receiveand dispose spilled water – A drain (15-30 meters
long) ending in a soak pit,garden or a field – A common bucket
should be used for drawingthe water – Well should be properly
covered on the top to prevent contamination from outside – There
should be no trees nearby – Distance from privy, drain or manure
heapshould not be less than 50 ft (15 meters) – It should not be low so
as to get flooded
289. What are the biological water quality standardsset out by WHO?
A. The WHO has set out the following criteria for water quality: – No
sample should have E.coli in 100 ml. – No sample should have more
than 3 coliforms per 100 ml.
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– Not more than 5% samples throughout the year should have
coliforms in 100 ml. – No two consecutive samples should
havecoliform organisms in 100 ml.
290. What are chemical water quality standards?
A. The WHO has set out three chemical qualitystandards:a. Toxic
substances – The upper permissible levels of lead,selenium, arsenic,
cadmium, cyanide andmercury are 0.05, 0.01, 0.05, 0.005, 0.05 and

0.001 mg / litre in domestic drinking water b. Substances that may

affect health – Fluorine should be present in a concentrationof 0.5 –
0.8 mg/l – Nitrates should not exceed 45 mg/l – Polynuclear aromatic
hydrocarbons shouldnot exceed 0.2 micrograms per litrec. Substances
that may affect water acceptability – Upper permissible limits have
been set outfor a number of substances like iron, lead,calcium,
chloride, sulphate, etc. – Total hardness should not exceed 2 meq/
liter
291. What is the presumptive coliform test?
A. This test is done on lactose bile salt mediumwhich is a selective
medium for colioform bacteria and is used to find the probable
number of coliform bacilli per 100 ml of water.
292. What are the methods for purification of water?
A. There are different methods for purification on alarge scale and on
a small (domestic) scale.
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109
Large scale – Storage – Filtration – ChlorinationSmall scale
(Domestic) – Boiling – Distillation – Addition of bleaching powder –
Addition of chlorine tablets, iodine, potassium permanganate or
alum – Household filtration like pot method or ceramic filters, etc.
293. What is a slow sand filter?
A. This is used for purification of water on a largescale and includes
the following: – Water head of 1.0 – 1.5 meters depth – Sand bed
(1.25 meters thick) composed of sand particles of 0.15 – 0.35 mm in
diameter supported on a layer of fine and coarse gravel – Drainage
system for the filtered water – Filter control valves in the outflow
pipe whichhelps to regulate the outflow of water
294. What is a rapid sand filter?
A. This is commonly used now. Before the water comes to the filter it
is subjected to a process of coagulation with alum. The filter bed
isessentially similar to slow sand filter with twodifferences: – The
sand is coarser – The biological membrane in slow filter isreplaced
by a layer of alum floc
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The rate of filtration in a rapid filter is 4000- 7500liters per square

meter as against 100 – 400 litersin a slow sand filter
295. What is break point chlorination?
A. This is the usual method of chlorination for largewater supplies. It
is that point in time when aschlorine is added to water, its chlorine
demandis met and free chlorine starts appearing in water.The
principle of break point chlorination is to addsufficient chlorine so
that 0.5 ppm of free chlorineis present in the water after 30 minutes of
contacttime.
296. What is super chlorination?
A. This is the method of choice for highly pollutedwaters. In his
method a high dose of chlorine isadded. After 20 minutes of contact,
dechlorinationis done with sodium sulphate or sodium thiosulphateto
reduce the taste of excess chlorine.
297. How is amount of bleaching powder to be addedto a well for disinfection
calculated?
A. The following steps are followed in calculatingthe amount of
bleaching powder required todisinfect a well:a. Quantity of water in
well should first becalculated by multiplying the surface area of water
with the depth of the water column. Theformula used is 3.146 x radius
in meters x depthof water in meters b. Add bleaching powder at rate
of 2.5 grams per 1000 liters of water. This will give about 0.7 mgof
applied chlorine per litre
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c. If one is not sure of quality of water in well,Horrock’s test can first
be performed to determineamount of bleaching powder to be added.d.
The required quantity of bleaching water is putin an enameled bucket.
Not more than 100grams should be added at a time in the bucket.e.
The powder is then made into a thin paste byadding a little quantity of
water.f. More water is added to make the bucket ¾ full.g. The mixture
is stirred wellh. The mixture is kept for 10 minutes to allow thelime to
settle down in the bucketi. The supernatant fluid is transferred to
another bucket. j. The second bucket containing the supernatantfluid
is then lowered into the well such that the bucket is completely
immersed in water.k. The bucket is then jerked up and down
andsideways vigorously so that the supernatantfluid mixes well with
the well water.l. At least 30 minutes time should be allowed before
water from the well is used.

m. It should be ensured that after one hour of contact, there is 0.5 mg

per litre of free chlorinein the well water.n. It is always preferable to
add the chlorine latein the day so that people can
comfortablywithdraw water the next day

298. What is the National Water Supply andSanitation Programme and

when was theprogramme started?
A. This program was started in 1954, and was further supplemented in
1972. During the fifth five year
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plan, this program was included under theMinimum Needs Program.
In 1981, the InternationalDrinking Water and Sanitation Decadewas
launched by Govt. of India. All the problemvillages without a safe
drinking water supply areto be provided at least one safe source under
the program. Problem villages are those where: – No source of safe
water is available within 1.6km radius – Water level is below 15
meters of depth – Sources where excess levels of iron, fluoride,saline
or other toxic elements are present in thewater. – Water source is
exposed to risk of cholera or guinea worm.
299. What is controlled tipping?
A. This is a method of safe disposal of refuse wherethe refuse is
placed in a designated area andcovered with a layer of earth.
300. What is the principle of functioning of anoxidation pond?
A. This is also called the stabilization pond. Natureis allowed to
purify sewage. The pond has thefollowing characteristics: – Presence
of bacteria feeding on organic matter – Presence of algae – Presence
of abundant sunlight.The main action of the bacteria is aerobic.
Theydegrade the organic matter to carbon dioxide,ammonia and
water. Algae use these productsfor photosynthesis, whereby oxygen is
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113
produced. This oxygen is used by bacteria for aerobic decomposition.
Anaerobic decompositiontakes place in the lower layers especially
atnight. Thus, the pond purifies sewage both byaerobic as well as
anaerobic decomposition.
301. What are the harmful effects of ionizingradiation?
A. These are: – Cancers

– Genetic malformations – Shortening of lifespan – Skin lesions –

Cataract
302. What are insecticides?
A. These are substances that kill insects.
303. What are contact poisons?
A. These are substances that kill insects when theycome in contact
with the substances. Theseinsecticides are absorbed by the cuticle of
theinsect and cause paralysis of the nervous system.
304. Name some common organophosphorus insecticides?
A. Some of the common organophosphoruscompounds used as
insecticides are: – Diazinon – Malathion – Dichlorovos – Parathion –
Chlorothion – Fenthion
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305. How will you treat a person suffering fromorganophosphate poisoning?
A. The following steps are followed in treatment: – Complete rest to
affected individual – Atropine ( 2 mg IV slowly) and
repeated every10-12 minutes till pupils are dilated – Oximes
(pralidoxime) I gram in 5 ml distilledwater IV. If this is not available,
bloodtransfusion may need to be considered. – Frusemide 40-80 mg.
IV – Care of respiration – General supportive measures
306. What are stomach poisons?
A. These kill insects on ingestion as they areabsorbed from the mid
gut. Sodium fluoride andformalin are common stomach poisons. They
area form of contact poisons.
307. What is a disinfectant?
A. Disinfectants are substances that destroy harmfulmicrobes. They
act by application and are usuallyineffective against spores. They can
be physical(sunlight, UV light, air, moist heat, ionizingradiation, etc.)
or chemical (phenol, cresol,chlorhexidine, chloroxylenol, alcohol,
formalin, bleaching powder, potassium permanganate, etc.)
308. What do you understand by the term carboliccoefficient?
A. Bactericidal activity of a disinfectant is comparedto the efficacy of
phenol and this is expressed ascarbolic coefficient.
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International Health
309. What is the international vaccination certificate?
A. This is essential for international travel. TheWHO has modified
the international vaccinationrequirements recently wherein only
vaccinationagainst yellow fever is mandatory for anybodytraveling
from a yellow fever-endemic-zone-tonon-endemic, zones. Diseases
like cholera etc. donot need any certificate now.
310. What is Quarantine? If you are not vaccinatedand are coming back to
India from West Africawhat will the Airport Health authorities do?
A. Quarantine is the restriction of activities of well persons or animals
who have been exposed to acommunicable disease or are traveling
from adisease-endemic-zone to a non-diseased-area for a period of
time equivalent to the longest knownincubation period of that specific
communicabledisease. This is done to prevent contact withindividuals
who are not exposed to a communicabledisease and to prevent
transmission toan area free of disease.
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311. What is modified quarantine?
A. This refers to selective partial limitation of movement of contacts
of communicable diseasesto protect susceptible individuals from
contractingdisease. Exclusion of children withchickenpox and
measles from regular school isan example.
312. When is World Health Day celebrated?
A. The World Health Day is celebrated on the 7thApril every year to
celebrate the birth of WHO.
313. When is World AIDS Day celebrated?
A. World AIDS Day is celebrated on 1st December every year.
314. What is the WHO and when was it founded?
A. WHO is the World Health Organization which isan organ of the
United Nations to cater to healthneeds of member countries. WHO is
specificallyconcerned with health services development, biomedical
research, prevention and control of specific diseases, international
health statistics,international health regulations, cooperation withother
agencies, family health, environmentalhealth and health literature and
information. Itwas founded on the 7th of April 1945

323. What do you understand by levels of prevention?

A. There are five levels of prevention. These are: – Health
promotion – Specific protection
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– Early diagnosis and treatment – Disability limitation –
RehabilitationHealth promotion and specific protection comeinto the
realm of primary prevention while earlydiagnosis and treatment falls
within secondary prevention and disability limitation
and rehabilitationare levels within the phase of tertiary prevention.
324. What do you understand by the term naturalhistory of disease?
A. This refers to the natural progression of thedisease process in the
absence of any interventionto arrest the disease.
325. What is multifactorial causation of disease?
A. It is now known that disease does not follow alinear pattern
wherein a person exposed to adisease causing organism definitely
developsdisease. Multiple factors are responsible for somebody to
develop a disease and others toescape the clutches of the disease.
Mycobacteriumis an essential cause of TB but is not asufficient cause
as factors like overcrowding,virulence, pathogenicity, disposal of
sputum andrelated behavior, nutrition, etc. are all importantcauses.
This is also referred to as the web of causation.
326. How does WHO define health?
A. Health is defined as a state of complete physical,mental, social and
spiritual health and not themere absence of disease or infirmity.
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327. What do you understand by tip of the iceberg?
A. Since all diseases progress along a gradient startingfrom contact
with a cause of disease to severedisability and death, one sees all
stages of diseasein a community. However, only the individualswith
overt manifestations and those with severedisability will be routinely
‘visible’ and a large proportion of disease is not visible to the
nakedeye. What is visible is called the tip of the iceberg

as only a small proportion of disease can actually be overtly seen and

the largest chunk is under thesurface, just like in the case of an
iceberg
328. What do you understand by time, place andperson distribution?
A. Diseases can be described by characteristics basedon when they
occur, where they occur and whoare the people who are affected. This
is calledthe time, place and person distribution.
329. Give some examples of how agent factors causedisease?
A. An agent is described as an organism, substanceor force, the
presence or lack of which may initiatea disease process or may cause
it to continue.Mycobacterium tuberculosis, deficiency of
iron,smoking, and radiation are agent factors causingTB, anemia,
coronary artery disease and cancersrespectively.
330. Give some examples of how external environmentalfactors cause
disease?
A. The quality of the environment plays an importantrole in disease
causation. Poor air quality causes
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disease like asthma and bronchitis, while poor environmental
sanitation and unsafe water causediseases like cholera, typhoid and
diarrhea.
331. What do you mean by lifestyle? In whichdiseases are lifestyle factors
very important?
A. Lifestyle is the sum total of habits, beliefs and practices. In
contemporary society harmfullifestyle factors have emerged. These
includesmoking, overnutrition, lack of exercise andsedentary lifestyle.
These are important causesof CAD and diabetes.
332. What are determinants of health?
A. These refer to the etiological or risk factors for adisease. In simple
terms these refer to factors,which determine why disease afflicts
someindividuals and why some individuals remaindisease-free. One
of the prime functions of epidemiology is to search for determinants
of disease.
333. What is disease eradication? How does it differfrom regional
elimination and control?
A. Eradication refers to the state where a disease nolonger exists
anywhere on the face of the earth. Ittherefore has a global
connotation. Regionalelimination refers to the complete elimination
of a disease from a country or a group of countries.Control is a more
benign term as it refers to asituation where a disease cannot
be completelyremoved but is brought down to levels where itis in
manageable proportions.

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334. What is incubation period?
A. This is the time duration from the receipt of infection by a human
host to the onset of clinicalmanifestations of the disease. During this
period,the organisms multiply but are not adequate to produce
symptoms.
335. What is an intermediate host?
A. The host in which the asexual development of anorganism occurs
is called the intermediate host.
336. What is extrinsic incubation period?
A. The length of time that a vector takes to becomeinfective to
humans from the time it received theorganisms of disease is referred
to as the extrinsicincubation period.
337. What is Surveillance?
A. This is the complete process of collection,compilation and analysis
of data which enables program managers to institute remedial
or corrective measures for detected deficiencies. Itis a process where a
strict vigil or watch ismaintained on the situation in a community.
338. What is the difference between Monitoring andEvaluation?
A. Monitoring is the process which is undertakento assess whether a
program is progressing onthe charted course while a program is
beingimplemented (Concurrent); evaluation refers toassessment of
gains and benefits of specificinterventions after completion of an
activity or intervention (Terminal).
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Occupational Health
339. What is Pneumoconiosis?
A. These are a group of lung diseases caused byinhalation of
insoluble dust particles. Particlesof 5 – 10 microns in size are sucked
into therespiratory tract while those measuring 3-5microns are
arrested in the mid respiratory passages. It is only particles of 0.5 –
3 micronsthat reach the smaller passages of the respiratorysystem that
cause pneumoconiosis.
340. What is the ESI Act?
A. This refers to legislation for Employees Healthand is called the
Employees State Insurance Act.The Act was passed in 1948 and
covers the wholecountry. The Act was further amended in 1975 to

increase the reach of services under the Act.Employees contribute

2.5% of their wage whilethe employer contributes 5% of the wage
bill.Under the Act, the following benefits are extendedto the workers

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– Sickness benefit – Maternity benefit – Disablement benefit – Dependent
benefit – Funeral benefit – Medical benefit – Rehabilitation benefit.
Social Medicine
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15
Social Medicine
341. What is an extended family?
A. Family is the basic unit of society. An extendedfamily is a linear extension of
a nuclear familyand consists of husband, wife and their marriedchildren living
together.
342. What are the characteristics of a joint family?
A. This is a lateral extension of a nuclear family inwhich he families of siblings
live together,wherein the males of the family are all related toeach other by
blood. The income, shelter andkitchen are usually common
though somemodifications have been occurring recently wherea portion of the
money is shared while another portion remains with the family of one
siblingand the kitchen is divided.
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343. What is the difference between a family and ahousehold?
A. In a family, all members are related either by blood or by marriage while this
is not the casewith a household where there is no blood or marital bonding but
people stay under acommon roof.
344. How can you determine socio economic statusin an urban area in India?
A. A number of scales are available for determiningsocio-economic status in the
rural areas. The UdayPareek scale is one example. Such scales give
dueweightage to land holdings and land produce asestimation of income in
agricultural communitiesis difficult.
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16
IEC
345. What is IEC?
A. IEC is the process of providing information toindividuals in a community
through the use of communication channels in such a manner thatthey are
motivated to assimilate the message andare educated to act. Health education
was theterm used earlier.
346. What are the characteristics of effective healtheducation?
A. The characteristics of effective health educationare: – Promotes actions
which are realistic and practical and feasible within the constraintsfaced by
individuals and communities. – Builds on ideas, concepts and practices
that people already possess. – Repeats and reinforces information over
time,using different methods.
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– Uses existing channels of communication – Attracts attention of
communities – Uses clear, simple and unambiguous language. – Provides
opportunities for dialogue anddiscussion – Demonstrates benefits of adopting a
particular practice.
347. What is role play?
A. This is a brief acting out of an actual situation for the benefit of the
audience to facilitate better understanding.
348. What is a symposium?
A. This is a modification of the didactic lecturemethod in which several experts
are allocateddifferent aspects of a particular topic to cover atopic
comprehensively. Each person tackles thetopic from his own perspective and
thereforeavoids monotony.
349. What is mass media?
A. Media which caters to a large proportion of people at the same time is
referred to as the massmedia. These could be print or non-print
media. Newspapers, TV, Radio are examples of massmedia.
350. What are flash cards?
A. These are a set of 15-20 cards about 40 cm x 50 cm

in size on which a particular theme is explained by pictures or line drawings.

The educator flashesthem in front of the audience while speaking.Educator
notes are written on the reverse and the
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cards are held at chest height while being presented.
351. What are folk media?
A. These are the traditional forms of media whichexist in the society and are
culturally acceptableto the communities. Nautanki, Kathputli, Katha,etc. are
examples of folk media.
352. What is Child-To-Child programme?
A. In this programme, children are providededucational inputs which they are
expected toimbibe and pass on relevant messages to theyounger siblings at
home and therefore care for the younger siblings in a better fashion.
353. What is Social Marketing?
A. This is merely the application of commercialmarketing principles to advance
a social cause,issue, behavior, product or service. It has beenused successfully
in promotion of condoms and ORT in India.